Surgical tool for robotic surgery and robotic surgical assembly

ABSTRACT

A robotic surgery assembly includes a medical instrument having a frame, a jointed device having a degree of freedom with respect of the frame, and at least one tendon made of polymer fibers configured for actuating the degree of freedom. The tendon includes a tendon endpoint connected to the medical instrument to exert a tensile load for actuating the degree of freedom.

This application is a Continuation-in-Part of U.S. patent applicationSer. No. 15/768,525, filed 13 Apr. 2018, which is a National StageApplication of PCT/EP2016/074808, filed 14 Oct. 2016, which claimsbenefit of Ser. No. 102015000062500, filed 16 Oct. 2015 in Italy andwhich applications are incorporated herein by reference. To the extentappropriate, a claim of priority is made to each of the above-disclosedapplications.

FIELD OF INVENTION

The present invention relates to a medical instrument.

In particular, the present invention relates to a medical instrumentspecifically suitable for acting as a robotic end effector for roboticmicrosurgery.

In addition, the present invention relates to a method of manufacturingof said medical instrument.

Moreover, the present invention relates to a robotic surgical assemblycomprising said medical instrument.

Further, the present invention relates to a tendon driving system for amedical instrument and to a medical instrument comprising said tendondriving system.

STATE-OF-THE-ART

Robotic assemblies for surgery or microsurgery comprising multi jointrobotic arms terminating with surgical instruments are known in thefield. For instance, document U.S. Pat. No. 71,553,116-B2 discloses arobotic assembly for performing brain microsurgery under MRI (MagneticResonance Imaging) guidance comprising an MRI-based image acquisitionsystem and two multi joint arms, each with three rotary joints withvertical axes to avoid direct gravity loads (as shown for instance inFIG. 7 of said document U.S. Pat. No. 7,155,316-B2), each connected toits respective end-effector endowed with an internal degree of freedomof motion for gripping.

Solutions available in the state-of-the-art, although offering partialadvantages, require a motion strategy that simultaneously involves aplurality of independent movements even for small motions of thesurgical instrument in the operating work-field, which results both in adifficult control of the kinematic accuracy and in a large encumbrancein the operating work-field, that in practice becomes inaccessible tothe Surgeon. As a matter of fact, the application field of the majorityof robotic assemblies for surgery that are based on the master-slaveparadigm are dedicated to use in minimally invasive surgery (or MIS),such as laparoscopic or endoscopic surgery. In both such applications,the kinematics of the robotic assembly is aimed to optimize the accessof the surgical instruments to the operating field through the surgicalports or orifices, a feat that requires the coordination of a pluralityof degrees of freedom of movement. In contrast, surgical, andmicrosurgical, applications in open surgery require an accuratekinematic control of translational movements, over a workspace limitedby the field of view of the operating microscope, without the limitingkinematic constraints represented by the surgical ports or naturalorifices, and thus benefit hugely from the surgeon's ability to directlyaccess the operating field.

It is also notable that the execution of the principal surgicalprimitives, such as tissue tensioning and anastomotic suturing, requiresthe ability to orient the surgical instrument tip in a large spatialcone of directions and to rotate the instrument around its longitudinalaxis (roll), for example to guide the needle through the tissue with thetip of the needle holder instrument, in a similar manner as the humanhand is jointed at the wrist and the elbow.

Robotic assemblies for surgery or microsurgery comprising a teleoperatedmaster-slave system are generally known, as described, for example, indocument U.S. Pat. No. 6,963,792-A and, more specifically for themicrosurgical application by U.S. Pat. No. 6,385,509-B2, andUS-2014-0135794-A1, that describe kinematic solutions for the movementof the surgical instrument tip that require coordination of a pluralityof joints in a serial kinematic chain that clutter the operating field.Such encumbrance effect is increasingly pronounced, as the jointsarticulating the tip of the instrument are further away from the tipitself. Moreover said micro-surgical systems do not allow adequatemovement, and more specifically adequate reorientation, of theinstrument tip when in an operating site inside a lesion as little as 10centimeters from the surface of the skin.

Generally, even a specialized operator requires long training to acquiremastery of the master command devices adopted in known master-slavesystems. In fact, known master devices have a long learning curve,primarily because they are mechanically linked to motion recordingstations, which necessarily limit their movement in an unfamiliar wayand often are of large dimensions. Hence, know master devices areintrinsically unfit to replicate the function of traditional opensurgery instruments and lack the ability to carry out a large spectrumof linear as well as angular movements in three-dimensional space.

For example, document U.S. Pat. No. 8,521,331-B2 discloses a roboticdevice for laparoscopic surgery, where the master command device has ashape that allows the surgeon to wear it as a glove on his-her fingers.According to another embodiment shown in FIG. 2B of said patent, themaster command device has a joystick shape, attached on one part to thesurgeon's wrist and extends so that it is held with just one hand,comprising a cylindrical stem having a pair of lateral wings that canregister the grip movement. A surgeon makes use of a laparoscopicdisplay device integral to said command device.

The above solution, although partly advantageous for laparoscopicsurgery, does not entirely solve the issue, making long training stillnecessary for the surgeon before becoming proficient at handling saidcommand devices instead of the familiar open surgery instruments.

As is well known, the practice of microsurgery requires the use ofeither an optical microscope or magnifying loupes, demands a high levelof dexterity and experience of the surgeon, who works at the limits ofphysiological tremor and the accuracy that human hand motions can reachat such dimensional scale.

The adoption of robotic technologies can bring about great benefits,allowing both a high degree of miniaturization of the instruments andscaling the size of the movements in the operating field, henceeliminating the effect of physiological tremor and easing the manualtask. For example, microsurgical procedures are carried out in severalphases of the reconstruction of biological tissues, such as for examplein the execution of blood vessel anastomosis, comprising small diametervessels, and nerves. Such procedures are carried out to reconstructanatomy after the occurrence of traumatic lesions or of lesions producedby surgical removal of tissue, to reattach limbs and to revascularizetissues, all performed in an open surgery set-up given the pre-existenceof a superficial lesion.

Others examples of application of microsurgical techniques are found intransplant surgery, neurosurgery or in vascular surgery, as well as insurgery around and inside the eye, and in the inner ear, as in the caseof cochlear implants. Also, the prominent surgical procedure of cardiacby-pass comprises the critical step of anastomosis of the coronaryarteries. The need for instrument miniaturization is also felt in othersurgical techniques, for example in minimal invasive surgery, such aslaparoscopy and endoscopy, which are aimed at limiting the invasivenessof surgical instruments on biological tissue. With reference tolaparoscopy, the technical solutions known in the art do not allow asatisfactory miniaturization of the diameter of the laparoscopicinstruments employed in Single Incision Laparoscopic Surgery or SinglePort Surgery. Moreover, it is worth noticing that the endoscopestypically employed in MIS have an instrument channel with a diameterbetween 1 mm and 3.2 mm. Such dimensions limit the functionality ofcurrent surgical instrumentation available through the endoscopeinstrument channel, which at present is typically just capable ofgripping action.

Medical instruments comprising a jointed device suitable to work on thepatient are generally known in the art. For example, documentWO-2010-009221-A2 shows a robotic surgical instrument comprising adistally jointed device, capable of providing three degrees of freedomof motion, respectively pitch, yaw and grip, employing just fouractuation cables. Such cables slide inside guiding channels, or sheaths,present inside the body of the articulating device.

Said technical solution limits the miniaturization of the roboticarticulating device, because friction between the guiding channelssurfaces and the cables that slide inside them limits the positioningprecision achievable by the articulating device. As it is known in theart, as the physical dimensions of medical instruments are reduced,difficulties arise which are related to the increase of relevance ofsuperficial forces, such as friction, that become dominant over volumeforces. Such a phenomenon requires to resort to solutions that minimizefriction forces, and at the same time reduce lost motions of mechanicsto a minimum. The loss of positioning precision of an articulatingdevice is a fundamental technological obstacle to furtherminiaturization of articulating instrument, since, with miniaturization,also the stiffness of the driving members (tendons) goes down with thesecond power of their diameter, making it even more difficult toovercome friction for the precise positioning of the instrument tip.Moreover such a solution requires a tendon guiding system comprisingchannels and guiding surfaces that surround the cables that make thepitch and yaw links, as well as the instrument shaft, very difficult tominiaturize using known fabrication methods, such as for exampleinjection molding and machining, and would be prone to have severallocations of mechanical weakness.

In order to simplify the miniaturization of a surgical instrument, thesaid document WO-2010-009221-A2 indicates the advantageous opportunityof reducing the number of actuation tendon terminations, associated tothree degrees of freedom, from six to four, exploiting for actuation thetorque that cables terminated on the yaw link apply on the pitch link(see FIG. 4-A of cited document) and requires to such purpose to pulland release selectively such cables, thanks to a kinematic mechanismcomprising a number of gears. Moreover, the driving system describedrequires that each end of an actuation tendon is attached to a winchthat selectively winds the tendon inducing the pull. The presence ofmechanical aspects such as said winch and said teeth, which arenotoriously subject to lost motion, creates a difficult to drive aminiature articulation, because lost motion in the drive system istranslated into an angular play at the joint, which increase as thearticulating device gets smaller. Said driving system is also unsuitedto keep a low preload on the actuation cables to further limit frictionand wear.

Moreover, the solutions described for tendon termination comprisetortuous paths meant to trap the tendon in some sections. Such solutionsrequire the use of cables that are sufficiently resistant to survivesuch trapping, such as steel cables or cables with larger diameter thanotherwise required.

Further examples of actuation cables for surgical instruments suited toslide, when pulled or pushed, inside sheaths or guiding channels, forexample obtained on the lateral surfaces of pulleys, are disclosed indocuments U.S. Pat. No. 6,371,952-B1, U.S. Pat. No. 6,394,998-B1 andWO-2010-005657-A2. Specifically, the latter document discloses asolution where actuation cables follow trajectories that cross as theygo around pulleys that comprise guiding channels to avoid that suchcables interfere with one another, a condition that limits theirefficacy in transmitting motion to the articulating device, such as forinstance in case of bundling up or sliding of one tendon onto anotherone. The provision of idle pulleys, necessarily with a diameter close tohalf of the instrument diameter (as shown in FIG. 4 of cited documentWO-2010-005657-A2) and attached to the links, for example to linksintegral with the instrument shaft, or to the pitch link, to guide thetendon to cross, is a considerable obstacle to miniaturization.Moreover, the provision of grooves and walls to realize the channels forthe actuation cables is a further obstacle to the miniaturization of theshaft or cannula diameter of a medical, or surgical, instrument.

The document US-2003-0034748-A discloses a solution suitable forreducing the diameter of the surgical instrument to 5.1 mm. Thisinstrument foresees the use of a series of disks that function asvertebra, providing some flexibility.

Nevertheless, this solution is not appropriate for achieving a compactjoint that can extend for approximately one instrument diameter, or inother words, has a radius of curvature similar to its diameter. This isinstead achievable by those articulations described in the documentscited above which are based on a pivot-type joint, comprised of a pureaxis of rotation.

A further obstacle to the miniaturization of jointed or articulateddevices is the challenge of fabricating and assembling three dimensionalmicromechanical parts with sufficient precision at a reasonable processcost. The need to develop relatively high forces at the tip in deviceswith a sub-millimeter size suggests the use extremely rigid metals forsuch components, such as for example tool steel.

It is known that biomedical devices are generally fabricated usingfabrication techniques derived from the microelectronic industry. Forexample, laser or water jet cutting is not appropriate for fastmachining in three dimensions. Injection molding does not currentlyproduce sufficiently high tolerance parts. In contrast, electricaldischarge machining (EDM) are capable of producing satisfactoryperformance both in terms of surface finishing and with respect to thegeometric tolerance required by the mechanical designs. EDM generallyentails a slow and expensive process. For example, the document U.S.Pat. No. 6,768,076-B2 discloses a fixture for EDM able to support piecesto be cut in a single plane.

Nevertheless the fixture is not suitable for repeated placement of thepiece, for example it is not possible to rotate the fixture while it isbeing machined in a way that the EDM can work in multiple cuttingplanes, resulting in a laborious fabrication process that necessitatescomplex operations of recalibration every time a cut is carried out in adifferent plane. This results in a loss of precision and hence lessprecise dimensional and geometric tolerances.

There is a felt need for a surgical robotic assembly able to carry outprecise motions and simply control a wristed medical instrument withinthe surgical workspace, for example an anatomical district of a patient.At the same time, there is a need to develop a reliable robotic assemblycharacterized by a simple driving method without compromising itsprecision. Furthermore, there is a need for a robotic assembly that ismore versatile than known assemblies and is able to carry out a widervariety of surgical procedures.

Hence, there is a felt need to provide a driver device for microsurgery,suitable to form a master interface in a robotic assembly formicrosurgery that comprises a master-slave type teleoperation systemthat is simpler and more intuitive to manipulate for the microsurgeonthan known solutions, without limiting its functionality. Equally, thereis a felt need to provide a master interface, which can be mastered morequickly and easily by the surgeon. Furthermore, there is a felt need toprovide a command device that is more versatile than the known solutionsand can be applied to different types of microsurgical procedures.

Hence, there is a felt need to provide a jointed or articulated medicalinstrument, or an assembly comprising a jointed or articulated device,which is structurally and functionally suitable for extrememiniaturization without compromising its reliability and safety. Thereis also a felt need to provide a jointed or articulated medicalinstrument, or an assembly comprising a jointed device, suitable forcarrying out a wide variety of medical-surgical therapies. Finally,there is a felt need to provide a jointed or articulated medicalinstrument, or an assembly comprising a jointed or articulated device,that is durable and able to undergo periodic maintenance withoutcompromising its sterility or reliability.

There is a felt need to provide a jointed or articulated medicalinstrument, or an assembly comprising a jointed device, that requiressimplified manufacturing compared to known solutions.

There is a felt need to provide a fabrication method of said medicalinstrument that is more efficient with respect to known solutions andthat guarantees the required level of precision for the assembly.

There is a felt need to provide a manufacturing method for a medicalinstrument that guarantees a faster machining process, withoutcompromising precision in production.

Furthermore, there is a felt need to provide a method of fabricationsuitable for producing parts subject to extreme miniaturization withoutreducing neither the precision of detailed manufacturing nor the ease ofassembly of the parts produced.

Hence, there is a felt need to provide a driver device based on tendons,or actuation cables, for a medical instrument suitable to be subject toextreme miniaturization, without compromising its precision orreliability in use.

Furthermore there is a felt need to provide a driver device based ontendons, or actuation cables, for a medical instrument that guaranteessaid tendons, a predetermined preload, even if light, and in which theforce of the preload can be independently defined for each of saidtendons.

Furthermore, there is a felt need to provide a drive system based ontendons, or actuation cables, for a medical instrument that canguarantee an adequate level of sterility to the medical instrumentitself, particularly to the portion of the medical instrument that ismeant to meet the patient anatomy.

Furthermore, there is a felt need to provide a drive system based ontendons without backlash.

Furthermore, there is a felt need to provide a drive system based ontendons that can replicate the drive precision achieved by precisionmicrometric slitters or piezoelectric drive systems, for example.

Hence, there is a felt need to provide a tendon, or actuation cable, fora medical instrument with characteristics that render it suitable forextreme miniaturization without compromising its resistance orreliability in use. Furthermore, there is a felt need to provide atendon for a medical instrument that is suitable for gliding over atleast one portion of said instrument with improved performance in termsof friction with respect to known solutions. Furthermore, there is afelt need to provide a tendon for a medical instrument exclusively meantto work under tensile load applied at its endpoints, without comprisingsolutions that might result in deflecting the path of the tendon thatwould diminish its resistance. Furthermore, there is a felt need toprovide a tendon for a medical instrument, as well as a method forreplacing the tendon, which is suitable for increasing the lifespan ofthe medical instrument, with respect to known solutions, withoutcompromising its performance in terms of sterility and reliability.

The need is felt to miniaturize medical instruments.

The need is felt to reduce the known dimensions of medical instruments.

For example document WO-2014-151952-A1 shows a medical instrumentcomprising a plurality of links forming a joined device, said medicalinstrument having actuation cables wrapping around a plurality ofpulleys rotatably supported on shaft provided cantilevered on the linksof the medical instrument. This solution is characterized by a highnumber of parts, and the layout of said pulleys provided on said shaftsforces to machining said shaft to resist to the stresses arising fromthe use of the medical instrument, therefore this solution resultsunsuitable for miniaturization, in fact this device could not measureless than 10 millimeters in diameter. Similar solutions are shown, forexample, in documents U.S. Pat. No. 6,676,684-A, US-2009-0112230-A andUS-2003-135204-A1.

It is therefore felt the need of reducing the number of parts that formsthe medical instrument.

For example, document WO-03-001986-A1 shows a medical instrumentcomprising a plurality of disc-shaped links forming a joined device,wherein each of said links comprises a plurality of holes for guidingthe actuation cables. Therefore, this solution is unsuitable forminiaturization as it is highly unsatisfactory performing micrometricholes in such links, and at the same time, it is unsatisfactoryproviding actuation cables that slide inside such holes withoutdamaging.

It is therefore felt the need of obtaining an accurate guiding of theactuation cables without providing micrometric holes in the links and atthe same time to reduce the number of parts that forms the medicalinstrument.

For example, document US-2008-177285-A1 discloses a medical instrumentcomprising a plurality of links, wherein some links comprise twoprotruding pins suitable to guide the deflection of the actuationcables. Although satisfactory under some points of views, such solutionis also unsuitable for miniaturizing, as the protruding pins dimensioncannot be reduced without compromise the integrity of the linkscomposing the medical instrument. Therefore, the need is felt to providea miniaturized medical instrument, having a plurality of links actuatedby means of actuation cables, without compromise the structuralresistance, and thus the safety when in use, of the medical instrument.

Miniaturization of surgical articulated instruments requireminiaturization of all the parts including actuation means such astendons in case of cable driven mechanism. Metallic multistranded cablesare commonly used to actuate articulated end effector of robotic wristedinstruments, endoscopes, or catheters; however together with all theparts composing surgical articulated instruments, the metal cables ortendons are difficult to be miniaturized and bring several functionaldrawbacks.

In particular, friction between micro metal tendons and otherminiaturized parts is very high, it requires a very high pulling forceand it even results in a substantial wear of metal tendon and instrumentparts thus drastically reducing instrumentation reliability, life andlimiting performance.

Moreover, the bending radius of metal multistranded tendons is extremelylimited impacting the possibility of a miniaturized instrument design.

Solution

One of the goals of the invention described here is to overcome thelimitations of known solutions described above and to provide a solutionto the needs mentioned with reference to the state of the art.

A Robotic surgery assembly comprises a medical instrument comprising aframe, and a jointed device having a degree of freedom with respect ofsaid frame, and at least one tendon made of polymer fibers designed foractuating said degree of freedom, wherein said at least one tendoncomprises a tendon endpoint connected to the medical instrument to exerta tensile load for actuating said degree of freedom. Preferably, the atleast one tendon actuating said degree of freedom are a pair of tendons.Said at least one tendon is designed to slide while in contact on atleast one portion of said jointed device to actuate said degree offreedom and said degree of freedom is preferably a rotational joint. Thejointed device may comprise a plurality of degrees of freedom. Accordingto an embodiment, said at least one portion of the jointed device onwhich said at least one tendon slide while in contact is formed by aconvex, ruled surface formed by a plurality of straight generator linesparallel to the axis of said rotational joint.

According to an embodiment, said at least one tendon is made of strands,for example strands raveled together. The strands may be composed bysaid polymeric fibers. The strands, also called yarns, may have arounded cross-section, for example a circular or oval cross-section,and/or a flattened cross-section with rounded edges. The strands mayhave different dimensions/sizes, for example different transversedimensions such as the diameter. All the strands can be substantiallyidentical according to an embodiment.

According to an embodiment, said at least one tendon is braided with apick-per-inches (PPI) generally in range 3-100. A local relative highPPI may increase the local stiffness of the braided tendon. Variousportions of the braided tendon may have different PPI resulting inlocalized stiffness variations.

According to an embodiment, the at least one tendon is braided with PPIin range 20-60. In other words, the tendon is made up by braidingpolymer fibers with a PPI of 20-60.

Preferably, the PPI of said at least one tendon is higher at a distalportion of the at least one tendon, wherein said distal portion islocated near said tendon endpoint along the tendon length and morepreferably the distal portion of the tendon comprises the distalendpoint. According to an embodiment, said distal portion having higherPPI has length which is equal or inferior to ⅓ of the tendon length, andpreferably equal or inferior to 1/10 of the tendon length, and morepreferably equal or inferior to 1/20 of the tendon length.

Preferably, said at least one tendon have an elastic module between 50GPa and 100 GPa. The tendon stiffness may vary along the tendon lengthresulting in localized stiffness variations.

According to an embodiment, the jointed device comprises a tendonfastening point where a tendon endpoint of a respective tendon isconnected to, and wherein the frame comprises a shaft, and wherein saidat least one tendon is more flexible close to or at the tendon fasteningpoint, and said at least one tendon is stiffer close to or inside saidshaft. The distal portion of said at least one tendon is preferably isbraided with PPI in range 25-100, and more preferably with PPI in range50-100. According to an embodiment, the at least one tendon comprisesfurther a proximal endpoint, and a longitudinal portion between saidendpoints. The tendon longitudinal portion may be braided with PPI inrange 3-30.

Preferably, said at least one tendon has a curvature radius inferior orequal to one millimeter.

According to an embodiment, said at least one tendon has transversedimension, for example its diameter, variable in different portions ofthe tendon. According to an embodiment, the at least one tendon isthinner at said tendon endpoint, wherein the at least one tendon isthicker in said longitudinal portion.

According to an embodiment, said at least one tendon has diameterbetween 0.05 mm and 0.3 mm.

According to an embodiment, said at least one tendon has compositionvariable in different portions thereof.

According to an embodiment, said at least one tendon has a core and ajacket. Said jacket may be made of braided polymeric strands. Accordingto an embodiment, also said core is made of braided polymeric strands.The polymer used for making up the braid may be polyethylene (PE). Thepolymer used for making up the braid may beultra-high-molecular-weight-polyethylene (UHMWPE). According to anembodiment, the core is not braided, and the jacket is braided.According to an embodiment, the jacket is not braided, and the core isbraided, and the jacket is in form of a coating, preferably a chemicalcoating, made of poly-dimethylsiloxane (PDMS) and/orpoly-tetrafluoroethylene, (PTFE). Said braided jacket may have a PPI inrange 25-100. According to an embodiment, said braided core has PPI inrange 3-30. According to an embodiment, the strands of the braidedjacket have transverse dimension, for example the diameter, inferior tothe transverse dimension, for example the diameter, of the strands ofthe braided core. According to an embodiment, the strands of the braidedjacket have linear density inferior to the linear density of the strandsof the braided core. According to an embodiment, said jacket is braidedand comprises further a coating, preferably a chemical coating, made ofPDMS and/or PTFE, and the core may be braided.

Preferably said convex, ruled surface is made in single piece with alink of the jointed device. Said jointed device preferably does notcomprise any sheath, groove or channel to guide said at least onetendon. Thereby said tendon as per being not received within a sheathdoes not form a Bowden cable, conversely the tendon slides over one ormore convex, ruled surface of the links of the jointed device to actuatethe degree of freedom of the jointed device.

The tendon endpoint is preferably locked by a knot formed by the tendonitself, the knot is located at said tendon fastening point of thejointed device. When a link of the jointed device comprises a windingsurface, the tendon winds around said winding surface, and the knot maybe located on said winding surface, for example the knot rests on saidwinding surface. Said at least one tendon may be made of a materialwhich is less hard, in other words softer, than the material of thejointed device.

The solution reported in the invention is an articulated medicalinstrument including tendons made by polymeric fibers allowing minimalbending radius together with very low friction and making possibleextreme miniaturization.

Together with the benefit of really miniaturized tendons in size anddiameter, polymeric tendons may have drawbacks of creep, low stiffness,limited wear resistance and poor termination strength.

The invention reports a list of fibers and materials such as PE, UHMWPE,PBO or Zylon®, Vectran, suitable for low friction, low bending radiusand high stiffness polymeric tendons.

In particular, the invention presents different design of multistrandspolymeric tendons resulting in maximization of stiffness, reduction ofcreep effect together with a very good wear resistance and withoutimpacting on low friction properties and flexibility and thus evenresulting optimal for articulated medical instruments miniaturization.

FIGURES

Further characteristics and advantages of the invention will appear fromthe description reported below of preferred embodiments, which are givenas examples and are not meant to be limiting, which makes reference tothe attached Figures, in which:

FIG. 1A is a perspective view, which shows the surgical robotic assemblyaccording to one aspect of the invention;

FIG. 1B is a perspective view, which shows the surgical robotic assemblyaccording to one aspect of the invention;

FIG. 1C is a perspective view, which shows a surgical robotic assemblyaccording to one aspect of the invention;

FIG. 2A is a perspective view, which shows a surgical robotic assemblyaccording to one aspect of the invention associated with other elementsof the operating room;

FIG. 2B is a frontal view, which shows a surgical robotic assemblyaccording to one aspect of the invention associated with other elementsof the operating room;

FIG. 3 is a perspective view, which shows a portion of a couple ofjointed or articulated devices according to one aspect of the invention.

FIG. 4A is a view from above, which shows a portion of a surgicalrobotic assembly according to one aspect of the invention associatedwith other elements of the operating room and a patient.

FIG. 4B is a top view, which shows a portion of a surgical roboticassembly according to one aspect of the invention associated with otherelements of the operating room and a patient.

FIG. 5 is a perspective view, which shows a portion of a surgicalrobotic assembly according to one aspect of the invention associatedwith other elements of the operating room and a patient.

FIG. 6 is a perspective view, which shows a portion of a surgicalrobotic assembly according to one aspect of the invention associatedwith other elements of the operating room, the surgeon and a patient.

FIG. 7 is a perspective view, which shows a control device according toone aspect of the invention.

FIG. 8 is a perspective view, which shows a macro-positioning armaccording to one aspect of the invention.

FIG. 9A is a perspective view, which shows a portion of a roboticassembly according to one aspect of the invention.

FIG. 9B is a perspective view, which shows a portion of a roboticassembly according to one aspect of the invention.

FIG. 9C is a perspective view, which shows a portion of a roboticassembly according to one aspect of the invention, associated with amicroscope.

FIG. 9D is a perspective view, which shows a portion of a roboticassembly according to one aspect of the invention, associated with anendoscope.

FIG. 9E is an enlarged view of the detail indicated with the arrow E-Eof FIG. 9C.

FIG. 10 is a perspective view, which shows a portion of a roboticassembly according to one aspect of the invention.

FIG. 11 is a perspective view, which shows a medical instrumentaccording to one aspect of the invention.

FIG. 12 is a perspective view, and a depiction of separate parts, whichshows a medical instrument according to one aspect of the invention.

FIGS. 13A and 13B show, in a perspective view, portions of a drivingsystem according to one aspect of the invention.

FIG. 14A is a schematic section view of a portion of a driving systemaccording to one aspect of the invention.

FIG. 14B is a schematic section view of a portion of a driving systemaccording to one aspect of the invention.

FIG. 15A is a perspective view that shows a medical instrument accordingto one aspect of the invention.

FIG. 15B is a perspective view that shows a medical instrument accordingto one aspect of the invention.

FIG. 15C is a sketch in perspective view that shows a medical instrumentaccording to one aspect of the invention.

FIG. 15D is a sketch in perspective view that shows a medical instrumentaccording to one aspect of the invention.

FIG. 15E shows a portion of a medical instrument for robotic surgery,according to an embodiment;

FIG. 15F shows a portion of a medical instrument for robotic surgery,according to an embodiment;

FIG. 16 is a schematic drawing, viewed from top and with partiallytransparent parts, which shows a tendon path of two tendons according toone aspect of the invention.

FIG. 17 is a perspective view of an articulated device according to anaspect of the invention.

FIGS. 18 to 20 are perspective views with isolated parts of someembodiments of an articulated device, according to several aspects ofthe invention.

FIG. 21 shows a profile of an articulated device according to one aspectof the invention.

FIGS. 22 to 24 show several poses of some embodiments of an articulateddevice according to some aspects of the invention.

FIGS. 25 to 27 shows several embodiments of a terminal tool according tosome aspects of the invention.

FIG. 28 shows a perspective view of a detail of a tendon according toone aspect of the invention.

FIG. 29 shows a perspective view of a detail of a tendon according toone aspect of the invention.

FIG. 30 shows a perspective view of a detail of a tendon according toone aspect of the invention.

FIGS. 31 to 36 are schematics, which show a path of the tendon accordingto some aspects of the invention.

FIG. 37 is a schematic in perspective view, which shows a machiningfixture according to one aspect of the invention.

FIG. 38 is a schematic, which shows the profile of a machining cutaccording to one aspect of the invention.

FIG. 39 is a schematic in perspective, which shows a phase of afabrication method according to one aspect of the invention.

FIG. 40A is a planar view, which shows a detail of a machining fixtureaccording to one aspect of the invention.

FIG. 40B is a perspective view, which shows a detail of a machiningfixture according to one aspect of the invention.

FIG. 41 is a schematic in perspective view, which shows a phase of afabrication method according to one aspect of the invention.

FIG. 42 is a frontal view of a tool according to one aspect of theinvention.

FIG. 43 is a perspective diagrammatic view of a tendon having a jacketand a core, according to an embodiment;

FIG. 44 is a diagrammatic view of a tendon, according to an embodiment.

DESCRIPTION OF PREFERRED EMBODIMENTS

According to an embodiment, the term “tendon”, or “actuation cable”,refers to an element that presents a prevalently longitudinal extensionand is suitable to work under tensile loads applied at its endpoints.According to an embodiment, the term “opposite tendon” or “oppositeactuation cable” refers to a further tendon suitable to work in anantagonistic way with respect to said tendon. According to anembodiment, in the attached figures, said tendon will generally beindicated by the numeric reference “90” and said opposite tendon will beindicated by the numeric reference increased by one hundred, that is“190”. Nonetheless, in figures in which distinguishing between saidtendon and said opposite tendon is irrelevant, said tendon and saidopposite tendon will both be indicated by the numeric reference 90.According to an embodiment, the concept of “opposite” extends itself tomultiple elements and/or parts of elements, such as referred to for said“tendon” above. According to an embodiment, the tendons comprised in afirst pair of tendons will be indicated with references “90, 190”, andthe tendons belonging to a second pair of tendons will be indicated withthe references “191, 192”.

According to an embodiment, the terms “master-slave”, “master” and“slave” refer to the known system of teleoperation.

According to an embodiment, the term “terminal tool” refers to a portionsuitable to perform an assigned task, such as for example form theinterface with at least on portion of the patient. For example, in ateleoperation system of the master-slave type, said terminal tool, orterminal portion, or terminal member, is at least one portion of an“end-effector”.

According to an embodiment, the term “jointed or articulated device”refers to a wrist joint, an elbow joint or a shoulder joint of a roboticor mechatronic structure, in other words, an interconnected assembly ofmembers and articulations suitable to support and/or orient and/orposition and/or influence the position of said terminal tool.

According to an embodiment, the members of a jointed or articulateddevice will be indicated by the progressive annotation “first member”,“second member”, and so on, to indicate their position within thekinematic chain, in which the “first member” indicates the most proximalmember; in other words “first member” indicates the member furthest fromthe terminal organ. According to an embodiment, the members of thejointed device will be indicated with the terms “wrist member”, “elbowmember” or “terminal member” to indicate the function exercised by saidmembers. For example, the same member could be simultaneously a “secondmember” and a “wrist member”.

According to an embodiment, the term “work volume”, or “work space”, or“work field”, or “workspace volume” refers to the set of Cartesian posesaccessible to the terminal portion of a jointed or articulated device.According to an embodiment, said volume is of a substantiallyparallelepiped form. According to an embodiment, said work volume is ofa substantially cylindrical form.

According to an embodiment, the term “macro-positioning” refers to aninitial operation of positioning of at least one portion of the medicalinstrument from any position to a work position within or adjacent tothe operating field; in other words, “macro-positioning” refers to theoperation of making the work volume coincide with the operating field.

According to an embodiment, the term “micro-positioning” refers to anoperation of positioning at least one portion of a medical instrument ina finer manner than the “macro-positioning”. According to an embodiment,the micro-positioning takes place in a more limited space, in real timeand under the direct control of the control device (master).

According to an embodiment, the prefix “micro-” before a certain objectindicates that said object is primarily, but not exclusively, meant tooperate on a sub-millimeter scale.

According to an embodiment, the term “rotational joint” refers to ajunction between two elements suitable to permit a relative moment ofrotation between said two elements around an axis of joint movement.

According to an embodiment, the term “medical instrument” refers to aninstrument suitable to be used during at least one phase of a medicalsurgical and/or cosmetic therapy. According to an embodiment, the term“surgical instrument” refers to a medical instrument specifically suitedto be generally used in at least one phase of a surgical therapy.According to an embodiment, the term “microsurgical instrument” or“surgical micro-instrument” refers to a medical instrument specificallysuited to be used in at least one phase of a microsurgical therapy.

According to an embodiment, the term “frame” refers to a portion of amedical instrument primarily suited to have a structural holdingfunction. According to an embodiment, the “frame” can comprise at leastone shaft that is a long rigid or flexible element that presents aprimarily longitudinal extension. According to an embodiment, saidshaft, for example can be of a hollow and/or tubular form.

According to an embodiment, the term “ruled surface” refers to a surfaceachieved by the union of multiple straight lines. According to anembodiment, if not otherwise explicitly stated, the term “ruled surface”refers to a surface achieved by the union of multiple straight linessubstantially parallel to each other, or in other words, a ruled surfaceof substantially parallel generatrices.

Below, when reference is made to a device, or an assembly, or a method,for microsurgery, it is meant a device, assembly or method, suitable tobe applied in microsurgery, i.e. with the simultaneous use of means ofoptical enlargement such as loupes or microscopes, but also suitable forapplications in other surgical therapies, such as general surgery,laparoscopic surgery or endoscopic surgery.

According to an embodiment, to not burden the text or figures, whenreference is made to a “first” or “second” element (for example a “firstmicro-positioning device” and a “second micro-positioning device”), theywill be indicated with the same numeric reference, as long as they arefunctionally indistinguishable (for example “41” above); sometimes, dueto a need for clarity, the numerical reference will be specifiedincremented by one hundred (for example “141” above and “241”); hence,for example, the numerical reference “41” will indicate both said “firstmicro-positioning device” and said “second micro-positioning device”, aswell as a “third” micro-positioning device. While when the specificreference, for example “141”, is used, it will refer to the specificelement, in this case the “first micro-positioning device”. Analogously,to not burden the text excessively, the numeric reference relating to an“opposite” element will be omitted, if an element is functionallyindistinguishable from its opposite.

According to a general embodiment, a medical instrument 60, 160, 260,360 for surgery comprises at least one frame 57 and at least one jointeddevice 70, 170, 270.

Said jointed device 70, 170, 270 comprising:

-   -   at least one first joint member 71, or first link 71, adapted to        connect to at least one portion of said frame 57;    -   at least one second joint member 72, or second link 72.

Said first joint member 71 is connected by means of a rotational joint171 to said second joint member 72.

Said medical instrument 60, 160, 260, 360 further comprising at least apair of tendons 90, 190, adapted to move said second joint member 72with respect to said first joint member 71, pulling it. Said tendonsacts as actuation cables suitable for working only in traction.

Each of said first joint member 71 and said second joint member 72comprises a main structural body comprising in a single piece one ormore convex contact surfaces 40, 80, 86, 140, 180,

Each of said convex contact surfaces 40, 80, 86, 140, 180 is a ruledsurface formed by a plurality of straight line portions all parallel toeach other and substantially parallel to a joint movement axis P-P, Y-Y.

According to an embodiment, all said convex contact surfaces 40, 80, 86,140, 180 defining with their prolongations thereof at least partially asingle convex volume In other words, the prolongations of said convexcontact surfaces 40, 80, 86, 140, 180 of a single main structural bodydefine, together with said contact surfaces 40, 80, 86, 140, 180, aconvex volume. According to an embodiment, the wording “convex volume”means that given a pair of points chosen inside said convex volume, theshorter straight conjunction between them is inside the convex volume inits entirety. This avoids providing grooves or channels on pulleys forguiding the tendons, allowing to miniaturize the dimensions of the mainstructural bodies and of the jointed device. According to an embodiment,all said convex contact surfaces 40, 80, 86, 140, 180 of said mainstructural body define with their prolongations thereof the convex hullof said main structural body.

According to an embodiment, wherein two tendons of said pair of tendons90, 190 are parallel to each other and in contact with the same convexcontact surface 40, 80, 86, 140, 180.

According to an embodiment, each tendon of said pair of tendons 90, 190comprises: a first tendon termination 91, associated to said frame 57, asecond tendon termination 92, secured to said second member 72, and amain portion, extending between said first tendon termination 91 andsaid second termination 92.

and wherein the main portion of each tendon of pair of tendons 90, 190is in contact with said jointed device 70, 170, 270 only on said convexcontact surfaces 40, 80, 86, 140, 180.

According to an embodiment, said contact surface 40, 80, 86, 140, 180 isa ruled surface formed by a plurality of straight line portions allparallel to each other and substantially parallel to a joint movementaxis P-P, Y-Y of the rotational joint 171 closer to said contact surface40, 80, 86, 140, 180.

According to an embodiment, said contact surface 40, 80, 86, 140, 180 isa sliding surface 40, 80, 140, 180 or a winding surface 86.

According to an embodiment, said sliding surface 40, 80, 140, 180 is aside sliding surface 40, 140, adapted to extend from said jointed device70, 170, 270 so as to make at least one tendon portion slide in the airor slide off the contact with said jointed device 70, or said slidingsurface 40, 80, 140, 180 is a joint sliding surface 80, 180, whichsurrounds at least partially a joint movement axis.

According to an embodiment, on said joint sliding surface 80, 180 saidtwo or more tendons 90, 190 overlap at least partially on a planeorthogonal to the direction of said joint movement axis of the closerrotational joint 171.

According to an embodiment, at least two tendons of said at least twopairs of tendons 90, 190, 191, 192 are in contact with a same convexcontact surface 40, 80, 86, 140, 180 and are parallel to each other.According to an embodiment, the two tendons of a said pair of tendonsare parallel to each other over a length of their tendon path in whichthey both are in contact with a said same convex contact surface 40, 80,140, 180 of said first joint member 71 and said second joint member 72.

According to an embodiment, said pair of tendons connected with a samejoint member is in contact with a same convex contact surface 40, 80,86, 140, 180.

According to an embodiment, said main structural body is a rigid body.

According to an embodiment, said medical instrument 60, 160, 260, 360comprises a further pair of tendons so as to comprise at least a thirdpair of tendons.

According to an embodiment, said convex contact surface 40, 80, 86, 140,180 is a sliding surface 40, 80, 140, 180 on which a said tendonsubstantially slides. Alternatively, said convex contact surface 40, 80,86, 140, 180 is winding surface 86 on which a said tendon substantiallywinds itself without sliding.

According to an embodiment, the projection of the tendon path T-T of afirst tendon of a said two pairs of tendons 90, 190, 191, 192 and theprojection of the tendon path T-T of a second tendon of same said pairsof tendons 90, 190 on a plane orthogonal to the direction of a saidjoint movement axis 171 crosses each other.

According to an embodiment, said medical instrument 60, 160, 260, 360comprising a pair of tendons 90, 190 for each joint member 71 or 72 or77.

According to an embodiment, said contact surface 40, 80, 86, 140, 180defines at least partially the convex hull of the joint member 71 or 72or 77 or 78;

According to an embodiment, each tendon 90, 190 defines a tendon pathT-T which remains stationary with respect to the joint member 71 or 72or 77 or 78 closer thereto.

According to a general embodiment, a medical instrument 60, 160, 260,360 includes:

-   -   at least a joint member 71, 72, 73, 74 of a jointed device 70,    -   a frame 57 including a shaft 65    -   a tendon 90,190 suitable to move said joint member 71, 72, 73,        74 with respect to said frame 57    -   a plunger 96 mobile along a degree of freedom with respect to        said frame 57, in contact with said tendon 90,190 and suitable        to actuate said tendon 90,190    -   a pushing element 95 mobile along a linear trajectory and        including an actuator    -   a sterile barrier 87 suitable to substantially impede mutual        bacteria contamination of the two environments it separates,        placed between said pushing element 95 and said plunger 96,        wherein said plunger 96 is free to move away from said sterile        barrier 87 and/or pushing element 95 and said pushing element 95        pushes on said sterile barrier 87 bringing it in contact with        said plunger 96 and thus moves said plunger 96.

According to an embodiment, said pushing element 95 pushes on a plunger96 in a pushing direction directed towards the inside of said frame 57,to move said plunger 96 along its degree of freedom with respect to saidframe 57.

According to an embodiment, said pushing element 95 exchanges with saidplunger 96 a force that is always directed in said pushing direction. Inother words, said pushing element 95 is not suitable to exchange withsaid plunger 96 a pulling force, in other words, said pushing element 95cannot pull said plunger 96.

According to an embodiment, said pushing element 95 includes a leadscrew and nut type actuator.

According to an embodiment, said actuator includes a ball screw.

According to an embodiment, said pushing element 95 includes a piston.

According to an embodiment, said plunger 96 has two portions one firstportion of plunger 145 suitable to be in contact with said pushingelement 95 and one second portion of plunger 146 to suitable to be incontact with said tendon 90, 190.

According to an embodiment, said first portion of plunger 145 is exposedfrom the frame 57 to be pushed by said pushing element 95.

According to an embodiment, said first portion of plunger 145 extendsoutside of frame 57 to be accessible by said pushing element 95.

According to an embodiment, said first portion of plunger 145 is flushwith said frame 57 to be accessible by said pushing element 95.

According to an embodiment, said first portion of plunger 145 includes apushing surface 147 suitable to be engaged with said pushing element 95.

According to an embodiment, said pushing elements 95 has a reciprocalpushing surface 148

According to an embodiment, said pushing element 95 pushes said plunger96 transmitting a linear force through said a reciprocal pushing surface148.

According to an embodiment, said pushing element 95 includes at leastone pushing element idle pulley not represented, suitable to push onsaid pushing surface 147.

According to an embodiment, said pushing element 95 pushes said plunger96 transmitting a linear force through said one pushing element idlepulley.

According to an embodiment, said pushing surface 147 and reciprocalpushing surface 148 are flat.

According to an embodiment, said pushing surface 147 and reciprocalpushing surface 148 are curved surface that mate with each other.

According to an embodiment, said pushing surface 147 and reciprocalpushing surface 148 are sliding surfaces that slide with respect to eachother as said pushing element 95 moves along a linear trajectory.

According to an embodiment, said second portion of plunger 96 in contactwith said tendon 90,190.

According to an embodiment, said medical instrument 60, 160, 260, 360includes at least one tensioning element 99, suitable for impose apreload on said tendon 90.

According to an embodiment, said tensioning element 99 is a spring.

According to an embodiment, said tensioning element 99 is suitable toapply a force between the frame 57 and the plunger 96, in the directionof moving said plunger 96 so as to impose a preload on said tendon 90.

According to an embodiment, said tensioning element 99 is suitable toapply a force between the frame 57 and the plunger 96, in the directionof moving said plunger 96 away from said pushing element 95.

According to an embodiment, said tensioning element 99 is suitable toapply a force between the frame 57 and the plunger 96, in the directionof moving said plunger 96 towards the inside of said frame 57.

According to an embodiment, said preload is substantially proportionalto the compression movement of said spring 99.

According to an embodiment, said second portion of plunger 146 pushes onat least one tendon deflectable portion 93 of said tendon 90.

According to an embodiment, said tendon deflectable portion 93 of saidtendon 90 extends from a first guiding pulley 197 and second guidingpulley 297.

According to an embodiment, said second portion of plunger 146 moves ina space provided between said a first guiding pulley 197 and said secondguiding pulley 297.

According to an embodiment, said plunger 96 changes the length of tendon90 path between said a first guiding pulley 197 and said second guidingpulley 297 of an amount linearly proportional to the plunger 96 motionalong said degree of freedom of plunger 96 with respect to said frame57.

According to an embodiment, said second portion of plunger 146 includesat least one plunger idle pulley 98, suitable to push on said tendondeflectable portion 93,

According to an embodiment, said tendon 90 has a first tendon endpoint91 fastened to said joint member 71, 72, 73, 74.

According to an embodiment, said tendon 90 has a second tendon endpoint91 fastened to said frame 57.

According to an embodiment, said first tendon endpoint 91, is fastenedto said second portion of plunger 146, instead than to said frame 57.

According to an embodiment, said frame 57 includes an upper frameportion 58 and a lower frame portion 59 the latter including a shaft 65.

According to an embodiment, said plunger 96 is mobile along a degree offreedom with respect to said frame 57.

According to an embodiment, said plunger 96 is jointed to said upperframe portion 58 with a linear joint.

According to an embodiment, said plunger 96 is jointed to said lowerframe portion 58 with a rotational joint not represented.

According to an embodiment, said plunger 96 moves linearly along adegree of freedom with respect to said frame 57.

According to an embodiment, said plunger 96 is maintained in a properalignment by means of linear bushings not represented inserted in thefirst frame section 58.

According to an embodiment, said plunger 96 is maintained in a properalignment with upper frame 58 by means of respective shoulder surfaces88.

According to an embodiment, said plungers 96 is a rocker that rotatesaround a pivot of said frame 57.

According to an embodiment, said sterile barrier 87 is of a form andmaterial suitable to transmit the push of said pushing element 95 tosaid plunger 96.

According to an embodiment, said sterile barrier 87 is a flexiblecontinuous layer of material.

According to an embodiment, said sterile barrier 87 lays in between saidpushing element 95.

According to an embodiment, said sterile barrier 87 is trapped betweensaid pushing surface 147 and said reciprocal pushing surface 148.

According to an embodiment, said medical instrument 60, 160, 260, 360includes a plurality of tendons 90 and of pairs of plungers 96 andassociated pushing element 95.

According to an embodiment, said sterile barrier 87 is a flexiblecontinuous layer of material.

According to an embodiment, said sterile barrier 87 is trapped betweeneach plunger 96 and associated pushing element 95.

According to an embodiment, said sterile barrier 87 is made of astretchable material that stretches as said plungers 96 move withrespect to said frame 57 exerting forces that do not substantiallyimpede the motion of said plungers 96.

According to an embodiment, said sterile barrier 87 is a drape.

According to an embodiment, said sterile barrier 87 is a loose fittingdrape that stretches as said plungers 96 move with respect to said frame57 exerting forces that do not substantially impede the motion of saidplungers 96.

Due to the provision of a pushing element 95 of a medical instrument 60,160, 260, 360 according to one aspect of the invention, suitable to movea jointed device across a sterile barrier allows the production of amedical instrument, which is highly reliable and sterile.

Due to the provision of a plunger 96 of a medical instrument 60, 160,260, 360 according to one aspect of the invention, it is possible toemploy a simple sterile barrier in a shape of a drape or continuousflexible sheet of material.

Due to the provision of a plunger 96 of a medical instrument 60, 160,260, 360 according to one aspect of the invention, it is possible toincrease the precision of the commanded motion using pushing elementswith high precision linear actuators.

Due to the provision of a plunger 96 of a medical instrument 60, 160,260, 360 according to one aspect of the invention, it is possible toprotect the tendons 90 inside said frame 57 while allowing sterilebarrier 87 to be external to said frame.

Due to the provision of a plunger 96 of a medical instrument 60, 160,260, 360 according to one aspect of the invention, it is possible toprovide tensioning to said tendons 90,190 for any joint member 71position of said jointed device 70.

Due to the provision of a plunger 96 of a medical instrument 60, 160,260, 360 according to one aspect of the invention, it is possible toavoid lost motion and backlash effects associated to changes ofdirection of motion of which are altogether avoided making use of acontinued pushing action of said pushing element on said plunger.

Due to the provision of a sterile barrier 87 of a medical instrument 60,160, 260, 360 according to one aspect of the invention, it is possibleto provide a sterile barrier that is not attached to pushing element andso it is easier to deploy for the surgical staff.

According to an embodiment, said pushing element 95 includes a sensor150.

According to an embodiment, said pushing element 95 includes a sensor150 suitable to detect contact between said pushing element 95 and saidplunger 96 through said sterile barrier 87.

According to an embodiment, said pushing element 95 includes a forcesensor 151 suitable to measure the pushing force exchanged between saidpushing element 95 and plunger 96 through said sterile barrier 87.

According to an embodiment, said force sensor 151 is a mono-axial loadsensor measuring a component of pushing force along the lineartrajectory of motion of said pushing element 95.

According to an embodiment, said pushing element 95 includes a pressuresensor 152 suitable to measure the pressure exchanged between saidpushing element 95 and plunger 96 through said sterile barrier 87.

According to an embodiment, said pressure sensor 152 is a thin filmpressure sensor glued to said reciprocal pushing surface 148 of saidpushing element 95.

According to an embodiment, said pushing element 95 includes anon-contact proximity sensor 153 suitable to measure the distancebetween said reciprocal pushing surface 148 and pushing surface 147through said sterile barrier 87.

Due to the provision of a pushing element 95 of a medical instrument 60,160, 260, 360 according to one aspect of the invention, suitable to movea jointed device across a sterile barrier allows the production of amedical instrument, which is highly reliable and sterile.

Due to the provision of a sensor 150 of a medical instrument 60, 160,260, 360 according to one aspect of the invention, it is possible tosense through a sterile barrier a sensed quantity related to theinteraction between said jointed device 70 and patient 201 anatomy.

Due to the provision of a sensor 150 of a medical instrument 60, 160,260, 360 according to one aspect of the invention, it is possible todetect contact between said pushing element 95 and plunger 96 through asterile barrier.

Due to the provision of a sensor 150 of a medical instrument 60, 160,260, 360 according to one aspect of the invention, it is possible tosense a pushing force through a sterile barrier related to tension oftendon 90,190.

According to a general embodiment, a robotic surgery assembly 100comprises at least one medical instrument 60, 160, 260, 360 according toany one of the embodiment as previously described.

According to one aspect of the invention, a surgical robotic assembly100 comprises:

-   -   at least one micro-positioning device 41, 141, 241, 341 having        multiple degrees of freedom at least of translation.    -   at least one medical instrument 60, comprising one jointed        device 70, or articulated device 70, having multiple rotational        degrees of freedom.

Said medical instrument 60 is connected in series, to saidmicro-positioning device 41 such that said articulated device 70 reachesa predefined position in a work volume 7 with its terminal portion 77.

According to an embodiment, said robotic assembly 100 comprises asupport 104 and at least one macro-positioning arm 30, connected to saidsupport 104, with respect to which said macro-positioning arm 30provides multiple degrees of freedom of macro positioning.

According to an embodiment, said micro-positioning device 41, 141, 241and 341 is connected in cascade, that is in series, to saidmacro-positioning arm 30.

The provision of a kinematic chain comprising a macro-positioning arm 30connected in series to at least one micro-positioning device 41comprising multiple degrees of freedom at least in translation,connected in series with a medical instrument 60, allows to decouple thepositioning movements in translation of the terminal portion 77 of saidmedical instrument 60 within said work volume 7, and the positioningmovements in orientation of the terminal portion 77 of said medicalinstrument 60 within said work volume 7.

According to an embodiment, said micro-positioning device 41 comprisesdegrees of freedom exclusively of translation.

According to an embodiment, said micro-positioning device 41 is aCartesian kinematic mechanism, suitable to determine translationalmovements along at least two mutually orthogonal directions. Accordingto an embodiment, said micro-positioning device 41 is a Cartesiankinematic mechanism, suitable to determine translational movements alongat least three mutually orthogonal directions.

According to an embodiment, said micro-positioning device 41 comprisesan X-Y-Z Cartesian kinematic mechanism and a further rotational degreeof freedom, around a rotational axis that substantially coincides withthe longitudinal direction in which the medical instrument develops.

According to an embodiment, said at least one medical instrument 60comprising one jointed device 70, has multiple degrees of freedom thatare exclusively rotational.

According to an embodiment, a robotic surgical assembly 100 comprises afurther micro-positioning device 41, such that it comprises at least afirst micro-positioning device 141 and a second micro-positioning device241.

According to an embodiment, said at least two micro-positioning devices141, 241 are placed parallel to each other. According to an embodiment,said at least two micro-positioning devices are placed side-by-side tomove one medical instrument on the right and one medical instrument onthe left.

According to an embodiment, a surgical robotic assembly 100 comprises afurther medical instrument 60 such as to comprise at least a firstmedical instrument 160, connected in cascade, or in series, to saidfirst micro-positioning device 141 and at least a second medicalinstrument 260, connected in cascade, or in series, to said secondmicro-positioning device 241.

According to an embodiment, said first medical instrument 160 comprisesone jointed device 170 and said second medical instrument comprises asecond jointed device 270.

According to an embodiment, said first micro-positioning device 141 andsaid second micro-positioning device 241 are placed in such a way thatthe respective terminal portions 77 of each jointed device 70 reachrespective work volumes 7 which must at least partially overlap.

The provision of work volumes 7 that at least partially overlap permitsan operation in context using at least two medical instruments on onesingle portion of the patient.

According to an embodiment, said at least two medical instruments 160,260 are placed parallel to each other.

According to an embodiment, said respective work volumes 7 substantiallycoincide.

According to an embodiment, said macro-positioning arm 30 comprises atleast one support member 38, comprising at least one attachment feature39, suited to hold at least one portion of at least onemicro-positioning device 41.

According to an embodiment, said support member 38 is suited tosimultaneously carry/receive at least one portion of said firstmicro-positioning device 141 and at least one portion of said secondmicro-positioning device 241.

According to an embodiment, said support member 38 comprises at leastone other attachment feature 39, such that it comprises at least threeattachment features 39, said further attachment feature 39 beingsuitable to hold at least one portion of a further micro-positioningdevice 41.

According to an embodiment, said robotic assembly 100 comprises at leastthree micro-positioning devices 41, 141, 241, 341.

According to an embodiment, said robotic assembly 100 comprises at leastthree medical instruments 60, 160, 260, 360.

According to an embodiment, said three medical instruments 60, 160, 260,360 are positioned in cascade, or in series, with a co-respectivemicro-positioning device 41, 141, 241, 341, of said at least threemicro-positioning devices 41, 141, 241, 341.

According to an embodiment, said first micro-positioning device 141,said second micro-positioning device 241 and said thirdmicro-positioning device 341 are located such that the terminalpositions 77 of each jointed device 70 reach respective work volumesthat are at least partially overlapping.

According to an embodiment, said support member 38 comprises at leastthree attachment features 39, each suited to hold at least one portionof a micro-positioning device 41.

According to an embodiment, said macro-positioning arm 30 has threedegrees of freedom.

According to an embodiment, said macro-positioning arm 30 has fivedegrees of freedom, and in which said five degrees of freedom are bothof rotation as of translation.

According to an embodiment, said five degrees of freedom of saidmacro-positioning arm 30 are a translational movement which issubstantially vertical, three movements which are substantiallyrotational around said first, second and third axis of movement of thearm a-a, b-b, c-c and at least one rotational movement around saidfourth axis of movement of the arm d-d.

According to an embodiment, said axes of movement of the arm can befixed or mobile with respect to a common reference system.

According to an embodiment, said macro-positioning arm 30 is a passivemechanism. In other words, according to an embodiment, saidmacro-positioning arm 30 is meant to be manually moved by an operator.

According to an embodiment, said macro-positioning arm 30 has sixdegrees of freedom, of which at least one of rotation. The provision ofthis characteristic allows the formation of an active anthropomorphicrobot, as shown in a non-limiting example in FIG. 1C. According to anembodiment, said macro-positioning arm 30 is an active anthropomorphicrobot. In other words, according to an embodiment, saidmacro-positioning arm is moved by a motorized system comprising astepper motor or a servo-motor.

According to an alternative embodiment, said macro-positioning arm 30 isa passive anthropomorphic robot.

According to an embodiment, said macro-positioning arm 30 has a radiusof extension of movement of 650 mm.

According to an embodiment, said macro-positioning arm 30 comprises:

-   -   one first arm member 31, connected to said support 104 and        mobile with respect to said support 104 along a linear sliding        guide 36,    -   a second arm member 32, connected to said first arm member 31        around a first axis of movement a-a.

The provision that said first member of the arm 31 is mobile withrespect to said support 104 along a linear sliding guide 36, allows fora up and down movement to get closer or further from the operatingfield.

According to an embodiment, said macro-positioning arm 30 furthercomprises a third arm member 33 connected to a second arm member 32 andmobile with respect to said second arm member 32 around a second axis ofmovement of the arm b-b.

According to an embodiment, said macro-positioning arm 30 furthercomprises a fourth arm member 34 connected to said third arm member 33and mobile with respect to said third arm member 33 around a third axisof movement of the arm c-c.

According to an embodiment, said macro-positioning arm 30 furthercomprises at least one rotational dial nut 43, which is mobile around afourth axis of movement of the arm d-d, and is suitable to bemanipulated to move said support member 38 around said fourth axis ofmovement of the arm d-d.

According to an embodiment, said five degrees of freedom of saidmacro-positioning arm 30 are a translational movement which issubstantially vertical, three substantially rotational movements aroundsaid first, second and third axis of movement of arm a-a, b-b, c-c andat least one rotational movement around said fourth axis of movement ofthe arm d-d.

According to an embodiment, said rotational dial nut 43 comprises aclick or non-continuous movement mechanism defining pre-establisheddisplacements.

According to an embodiment, there is a reduction in the transmission ofrotational movement between said rotational dial nut 43 and said supportmember 38. In other words, big angular movements of said rotational dialnut correspond to small angular movements of said support member 38, ina similar manner to an objective of a camera.

Provisioning said support member 38 to be mobile by a rotationalmovement around said fourth axis of movement of the arm d-d allows thepositioning of said terminal portion 77 of said at least one medicalinstrument 60, associated to said macro-positioning arm 30, in proximityof a predetermined portion of the patient 201 with a favorable anglebetween the instrument shaft and the anatomy plane, steeper or shallowerto facilitate suturing on different anatomical planes.

According to an embodiment, said rotational dial nut 43 comprises atleast one milled handle This provides for finer control.

According to an embodiment, said first axis of movement of the arm a-a,said second axis of movement of the arm b-b and said third axis ofmovement of the arm c-c are substantially parallel to each other.

According to an embodiment, said fourth axis of movement of the arm d-dis substantially orthogonal to said third axis of movement of the armc-c.

According to an embodiment, a manual knob 37 moving a rack and pinionmechanism controls the movement of said first member of the arm 31 insaid linear sliding guide 36 by its rotational movement.

According to an embodiment, said macro-positioning arm 30 comprises atleast one braking system, suitable for blocking the relative movement ofat least two of said support 104, said first member of the arm 31, saidsecond member of the arm 32, said third member of the arm 33, saidfourth member of the arm 34.

According to an embodiment, said braking system comprises at least oneelectromagnetic brake device.

According to an embodiment, said macro-positioning arm 30 comprises atleast one release button 35, or unlocking button, which can be switchedbetween a brake (or lock) and a release (or unlock) position.

According to an embodiment, said braking system can be released by arelease button 35.

According to an embodiment, said release button 35 can be switchedbetween a brake position and a release position.

According to an embodiment, said release button 35, when in the releaseposition, allows the operator to move, by carrying it around, at leastone of the degrees of freedom of said macro-positioning arm 30.

According to an embodiment, when it is in its release position, saidrelease button 35 is able to release the braking system, allowing thesimultaneous relative movement of at least two of said support 104 andsaid first member of the arm 31, said second member of the arm 32, saidthird member of the arm 33 and said fourth member of the arm 34.

According to an embodiment, when it is in the release position, saidrelease button 35 is suitable to inactivate said arrest system, allowingthe simultaneous relative movement of said first member of the arm 31,said second member of the arm 32, said third member of the arm 33 andsaid fourth member of the arm 34.

According to an embodiment, said release button 35 is suitable to workby pressure, when it is depressed it is in said release position, andwhen it is raised or undepressed it is in said arrest position.

According to an embodiment, said robotic assembly 100 comprises:

-   -   said macro-positioning arm 30, passively mobile by releasing        said release system,    -   said at least one micro-positioning device 41 and said at least        one articulated device 70, actively controlled by master slave        teleoperation, from the movement of said control instrument 21        as performed by the surgeon 200.

According to an embodiment, said micro-positioning device 41, 141, 241has three degrees of freedom of translation.

According to an embodiment, said micro-positioning device 41, 141, 241has four degrees of freedom, of which three are of translation.

According to an embodiment, each micro-positioning device 41 comprises aspherical joint 173, said spherical joint 173 is positioned in cascade,or in series, upstream of each micro-positioning device 41.

According to an embodiment, for example shown in FIG. 2B, eachmicro-positioning device 41, 141, 241 comprises a spherical joint 173,suitable to change the orientation of the medical instrument 60, 160,260 by moving the micro-positioning device 41, 141, 241, from its base,i.e. most proximal portion. According to an embodiment, said sphericaljoint 173 is a universal joint that can be blocked.

According to an embodiment, said micro-positioning device 41 comprises afirst motorized slide 51, mobile along a first sliding rail 54 along afirst sliding direction f-f.

According to an embodiment, said micro-positioning device 41 comprises asecond motorized slide 52, mobile along a second sliding rail 55 along asecond sliding direction g-g.

According to an embodiment, said micro-positioning device 41 comprises athird motorized slide 53, mobile along a third sliding rail 56 along athird sliding direction h-h.

According to an embodiment, said first sliding direction f-f issubstantially rectilinear.

According to an embodiment, said second sliding direction g-g issubstantially rectilinear.

According to an embodiment, said second sliding direction g-g issubstantially orthogonal with respect to said first sliding directionf-f.

According to an embodiment, said third sliding direction h-h issubstantially rectilinear.

According to an embodiment, said third sliding direction h-h issubstantially orthogonal with respect to both said first slidingdirection f-f and said second sliding direction g-g. According to anembodiment, the third sliding direction h-h is aligned with the shaft65.

According to an embodiment, said micro-positioning device 41 is suitablefor working with a stepper motor or a servo-motor. According to anembodiment, said micro-positioning device 41 is suitable to work with apiezoelectric motor or an ultrasonic motor.

According to an embodiment, at least one motorized slide 51, 52, 53 ofsaid first, second and third motorized slides, is connected to a motorvia a transmission mechanism comprising a ball screw which rotates withrespect to the respective slide rail 54, 55, 56 and is held by a nut.

According to an embodiment, said nut is solid to at least one motorizedslide 51, 52, 53 of said first, second and third motorized slides.

The provision of a transmission mechanism comprising a coupling of apreloaded ball or lead screw-nut type confers an improved control ofmovement to the motorized slide as well as decreased backlash.

According to an embodiment, at least one motorized slide 51, 52, 53 ofsaid first, second, third motorized slides, and is connected to a motorby a transmission mechanism comprising a cogged belt.

According to an embodiment, said motorized slides 51, 52, 53 areprecision micro-slides having a stroke between 1 cm and 10 cm, andhaving precision in the 0.1 micron and 25 micron range.

According to an embodiment, said motor is a servo-motor. According to anembodiment, said motor is a stepper motor.

According to an embodiment, said medical instrument 60 comprises amotorized rotary joint 46, suitable for moving said medical instrument60 around a longitudinal axis of rotation r-r.

According to an embodiment, said micro-positioning device 41 alsocomprises a motorized rotary joint 46, suitable for moving said medicalinstrument 60 around a longitudinal axis of rotation r-r.

According to an embodiment, said axis of longitudinal rotation r-rsubstantially coincides with its longitudinal axis of development, oraxis of the instrument X-X, or longitudinal axis of the shaft X-X, ofsaid medical instrument 60. According to an embodiment, a shaft angle θis defined as the angle between the shaft direction X-X of the shaft 65of said first medical instrument 160 and the shaft direction X-X of theshaft 65 of said second medical instrument 260.

According to an embodiment, said medical instrument 60 comprises onearticulated device 70 with two degrees of freedom of rotation. Accordingto an embodiment, said medical instrument 60 comprises one articulateddevice 70 with two degrees of freedom of rotation orthogonal to eachother to form a jointed wrist.

According to an embodiment, said medical instrument 60 comprises ajointed device 70 with at least three degrees of freedom. According toan embodiment, said jointed device 70 has three degrees of freedom ofrotation, of which two degrees of freedom of rotation around axesparallel to each other and a third degree of freedom of rotation aroundsaid longitudinal axis of rotation r-r.

According to an embodiment, said jointed device 70 has three degrees offreedom of rotation, of which one first degree of freedom of rotation,around a first axis of rotation orthogonal to the axis of the instrumentX-X, one second degree of freedom of rotation parallel to the first axisof rotation and a third degree of freedom of rotation orthogonal to thesecond axis of rotation, such that said second and third degrees offreedom of rotation are close to each other and form a sub-articulationof the wrist.

According to an embodiment, said medical instrument 60 comprises ajointed device 70, which has a further degree of freedom in its terminalportion 77, said further degree of freedom allows an opening and/orclosing movement of said terminal portion 77. According to anembodiment, said jointed device 70 comprises a terminal device 77 insaid distal portion, in which said terminal device 77 comprises saidfurther degree of freedom of opening and/or closing. For example, saidfurther degree of freedom determines the opening and/or closing offorceps or of a cutting instrument, such as scissors.

According to an embodiment, said at least one medical instrument 60 isconnected in a detachable fashion to said robotic assembly 100.

According to an embodiment, said medical instrument 60 comprises atleast a shaft 65, suitable to connect said frame 57 with said jointeddevice 70.

According to an embodiment, said medical instrument 60 comprises atleast one shaft 65 such as to position its jointed device 70 at apredefined distance from said micro-positioning device 41. According toan embodiment, said shaft 65 is suitable for distancing said jointeddevice 70 from said micro-positioning device 41 by a predefineddistance.

According to an embodiment, said predefined distance is a multiple ofthe longitudinal extension of said jointed device 70. According to anembodiment, said predefined distance is equal to at least five times thelongitudinal extension of said jointed device 70. According to anembodiment, said predefined distance is equal to at least twenty-fivetimes the longitudinal extension of said jointed device 70. According toan embodiment, said predefined distance is equal to substantially twentytimes the longitudinal extension of said jointed device 70. According toan embodiment, said predefined distance is measured along thelongitudinal direction of the shaft X-X. According to an embodiment,said predefined distance is equal to substantially fifty times thelongitudinal extension of said jointed device 70.

The provision of said shaft 65 which distances said micro-positioningdevice 41 and said jointed device 70 allows for the fabrication of saidmicro-positioning device 41, as well as said jointed device 70 to be ofdimensions that are appropriate for them to fulfill their functions whenin operating conditions. When said robotic assembly 100 comprises aplurality of medical instruments 60, 160, 260, 360, the provision ofsaid shaft 65 in each medical instrument 60, 160, 260, 360 whichdistances the respective micro-positioning devices 41, 141, 241, 341from the associated jointed devices, allows for the terminal portions 77of each medical device to reach their own work volumes, while keepingtheir ability to move independently.

According to an embodiment, said shaft 65 is suitable to connect to saidframe with said terminal device 77 at a predefined distance from saidframe 57.

According to an embodiment, said shaft 65 is rigid.

According to an embodiment, said shaft 65 has a longitudinal extensionbetween 30 mm and 250 mm, and preferably between 60 mm and 150 mm.

According to an embodiment, said shaft 65 has a longitudinal internalhole. According to an embodiment, said shaft 65 has a hollow tubularform.

According to an embodiment, said medical instrument 60 comprises a motorbox 61 suitable to house at least one driving system of at least saidjointed device 70, of said medical instrument 60. In this way, theactuation of said jointed device 70 happens internally to said medicalinstrument 60.

According to an embodiment, a robotic assembly 100 comprises at leastone control device 20, suitable to determine the movement of at leastone portion of said medical instrument 60, 160, 260, by a master-slavetype communication system.

According to an embodiment, said assembly comprises a further controldevice 20, such that it comprises at least two input devices 20.According to an embodiment, said control device 20 is suitable todetermine the motion of said jointed device 70 of said medicalinstrument 60. According to an embodiment, said control device 20 issuitable to determine the movement of said micro-positioning device 41.The provision of said characteristic allows a translational movement ofsaid control instrument 21 as registered by said detection device 22 tobe associated to a translational movement of said terminal device 77within its workspace 7, 17.

According to an embodiment, said control device 20 is suitable todetermine the motion of said micro-positioning device 41 and saidmedical instrument 60.

The provision of this characteristic allows to move at least a portionof said micro-positioning device 41 and at least a portion of saidmedical instrument 60 by means of said control instrument 21, such as todetermine both rotational and translational movements of said terminaldevice 77 in said work volume 7.

According to one alternative embodiment, said micro-positioning device41 comprises a plurality of passive degrees of freedom that can bebraked or otherwise blocked. According to an embodiment, said pluralityof degrees of freedom is placed immediately upstream and in series tosaid micro-positioning device 41.

According to an embodiment, said robotic assembly 100 is suitable tocooperate with a vision system 103 associable to said robotic assembly100.

According to an embodiment, said vision system 103 is a microscope 103.

The provision of a microscope 103 associable to said robotic assemblyallows for retro-fitting with pre-existing microscopes, making saidrobotic assembly 100 more versatile. For example, said robotic assembly100 can be used in cooperation with microscopes that have a focusingdistance between 100 mm and 500 mm, depending on the focal length of theobjective lens used. Furthermore, it allows the swept volume of therobotic assembly 100 to be reduced, during the surgical operation giventhat it lacks as many parts as possible that require relatively largemovements during the movement of the terminal portion of the instrument.

According to an embodiment, said microscope 103 is an optical microscope103.

According to an embodiment, said microscope 103 is suitable to frame inits field of view said terminal portion 77 of said first medicalinstrument 160 and/or said terminal portion 77 of said second medicalinstrument 260 and/or said terminal portion of said third medicalinstrument 360.

According to an embodiment, said microscope 103 is suitable for framingthe work volume 7.

According to an embodiment, at least one video-camera 45 is connected tosaid support member 38.

According to an embodiment, said video-camera 45 is suitable for framingsaid terminal portion 77 of said first medical instrument 160 and saidterminal portion 77 of said second medical instrument 260.

According to an embodiment, said support 104 comprises at least onedisplay 111, suitable to form a machine input interface.

According to an embodiment, said display 111 is suitable to visualizethe images acquired by said video-camera 45.

According to an embodiment, said video-camera 45 is suitable tocooperate with said macro-positioning arm 30 to permit the correctpositioning of said at least one medical instrument 60. The provision ofthis characteristic facilitates the positioning process of at least oneportion of said at least one medical instrument 60 within the workvolume 7.

According to an embodiment, said first medical instrument 160, saidsecond medical instrument 260 and said support member 38 are disposed insuch a way that they substantially form a triangle. Such provisionallows to reproduce of the same triangulation existing between the eyesand the arms of the surgeon by means of said robotic assembly 100.

According to an embodiment, said support 104 is at least one of: amobile cart, a support structure of a microscope, an operating bed, anoperating table.

According to one aspect of the invention, a control device 20 formicrosurgery for a robotic assembly for microsurgery 100, in which saidcontrol device 20 is suitable to at least partially form the masterinterface of a master-slave pair for a robotic assembly for microsurgery100, comprises:

at least one control instrument 21, mobile in space, of a shape and sizewhich lends it to being held and handled like a traditional surgicalinstrument, that is to say a surgical instrument suitable to operatedirectly on at least one portion of the patient anatomy 201,

at least one detection device 22, suitable to detect the position ofsaid control instrument 21 in at least on portion of space.

Said control instrument 21 comprises at least one position sensor 28,which cooperates with said detection device 22, to sense at least theposition of said control instrument 21.

According to an embodiment, said detection device 22 generates anelectromagnetic field such as to detect at least the position of saidcontrol instrument 21 by detecting the position of said at least oneposition sensor 28. According to an embodiment, said detection device 22detects at least the position of said control instrument 21 by detectingthe position of said position sensor 28 by measuring at least inertialaccelerations components. According to an embodiment, said positionsensor 28 comprises accelerometers.

According to an embodiment, said detection device 22 is positioned in abase structure 67 of said control device 20.

According to an embodiment, said control instrument 21 is connected tosaid detection device 22 by at least an electromagnetic communicationsystem.

According to an embodiment, said control instrument 21 comprises atleast one forceps articulation 69, effective in a tip portion 68 of saidcontrol instrument 21, such as to allow said tip portion 68 a graspingor cutting movement.

According to an embodiment, at least one tip sensor 29 measures anopening angle of said forceps articulation 69.

According to an embodiment, said control instrument 21 has a shape thatsubstantially replicates the shape of a traditional surgical instrument.

According to an embodiment, said control instrument 21 has the shape ofsurgical forceps.

According to an embodiment, said control instrument 21 has the shape ofa surgical scalpel.

According to an embodiment, said control instrument 21 has the shape ofa surgical needle holder.

According to an embodiment, said control instrument 21 has the shape ofsurgical scissors.

According to an embodiment, said control instrument 21 has the shape ofa surgical blade.

According to an embodiment, said control device 20 comprises at leastone ergonomic support element for the operator 27, comprising at leastone support surface for the operator 25, suitable to support at leastone portion of the forearm of the micro-surgeon 200, at least when inoperating conditions, such as to provide ergonomic support for themicro-surgeon 200. The provision of such a characteristic allows forimproved comfort of the micro-surgeon, determining an improved operatingefficiency.

According to an embodiment, said ergonomic support element 27 comprisesat least one portion made of soft material or foam.

According to an embodiment, said control instrument 21 is connected tosaid detection device 22 by at least one system of electromagneticcommunication. According to an embodiment, said position sensor is anelectromagnetic position sensor with micro-bobbins and said sensordevice comprises a generator of a magnetic field and an electric circuitthat reads the circuit induced in said micro-bobbins by said magneticfield. The provision of this characteristic allows the controlinstrument 21 to preserve its functioning as a traditional surgicalinstrument, without affecting a response time for said detection device22.

According to an embodiment, said control instrument 21 is connected tosaid detection device 22 by a wired connection, or cable.

According to an embodiment, said control instrument 21 is connected tosaid detection device 22 by a wireless connection.

According to an embodiment, said detection device 22 is suitable tomeasure the position in space, this position measure being either byinduced current, or it is an optic measure, or an ultrasound measure, ora measure by ionizing radiation.

According to an embodiment, said control device 20 comprises an on-offtype switch, either implemented as a pedal or as a button, selectivelysuitable to activate or deactivate input from said control device 20.

According to an embodiment, a robotic assembly 100, comprises:

-   -   at least one control device 20, as described by one of the        embodiments described above,    -   at least one surgical micro-instrument 60, 160, 260, 360        comprising at least one terminal portion 77.

According to an embodiment, said terminal portion 77 is suitable tooperate on at least one portion of the patient 201.

According to an embodiment, said terminal portion 77 is suitable tohandle a surgical needle 202, as shown for example in FIG. 3A-3B.

According to an embodiment, said control instrument 21 has the samedimensions and offers the same handling experience of a traditionalsurgical instrument, that is to say a surgical instrument that can beused to operate directly on at least one portion of a patient 201, andsaid surgical micro-instrument 60 is suitable to replicate the sameentire movement capability of said control instrument 21.

According to an embodiment, said robotic assembly 100 is suitable todecouple the movements of said control instrument 21 and said surgicalmicro-instrument 60 in such a way that when the movements of saidcontrol instrument 21 are large and comprise vibrations, while themovements of said surgical micro-instrument 60 are filtered ofvibrations and reduce the movement to a millimeter or to a micron scale.The provision of scaled movement introduced between the master interfaceand the slave interface allows for the reduction of tremor as well as animprovement of precision of said surgical micro-instrument withoutdecreasing the ease of operation of the surgeon 200.

According to an embodiment, said control instrument 21 is suitable tocooperate with said surgical micro-instrument 60 in such a way that,when in operating conditions, at a first 3D movement of said controlinstrument 21 with respect to said detection device, corresponds to asecond 3D movement of said surgical micro-instrument 60.

According to an embodiment, said control instrument 21 is suitable tocooperate with said surgical micro-instrument 60, 160, 260, in such away that, when in operating conditions, a first translational movementof said control instrument 21 corresponds to a second translationalmovement of said surgical micro-instrument 60, 160, 260 equal to afraction of the amplitude of said first movement of said controlinstrument 21. In this way, it is possible to limit the transmission oftremor or vibration of the control instrument 21 to the surgicalmicro-instrument 60.

According to an embodiment, said control instrument 21 is suitable tocooperate with said surgical micro-instrument 60, 160, 260 in such a waythat, when in operating conditions, a first translational movement ofsaid control instrument 21 corresponds to a second translationalmovement of said surgical micro-instrument 60, 160, 260 of an amplitudethat is substantially equal to one tenth of the amplitude of said firstmovement of said control instrument 21.

According to an embodiment, said control instrument 21 is suitable tocooperate with said surgical micro-instrument 60, 160, 260 such that,when in operating conditions, a first translational movement of saidcontrol instrument 21 corresponds to a second translational movement ofsaid surgical microinstrument 60, 160, 260 of an amplitude substantiallyequal to one thirtieth of the amplitude of said first movement of saidcontrol instrument 21.

According to an embodiment, said control instrument 21 is suitable tocooperate with said surgical micro-instrument 60, 160, 260 in such a waythat, when in operating conditions, a first angular movement of saidcontrol instrument 21 corresponds to a second angular movement of saidsurgical micro-instrument 60, 160, 260, said second angular movement ofthe micro-instrument being of an amplitude that is substantially equalto the amplitude of said first movement of the control instrument 21.The provision of such a characteristic renders the use of said controlinstrument 21 familiar to a surgeon 200.

According to an embodiment, said control instrument 21 is suitable tocooperate with said surgical micro-instrument 60, such that, when inoperating conditions, a first angular movement of said forcepsarticulation 69 of said control instrument 21 corresponds to a secondangular movement of an articulation, situated on said terminal portion77 of said surgical micro-instrument 60, the amplitude of said secondmovement being substantially equal to said first angular movement ofsaid forceps articulation of said control instrument 21.

According to an embodiment, said a portion of control instrument 21 isof a shape that substantially reproduces the shape of said terminalportion 77 of said surgical microinstrument 60, 160, 260.

According to an embodiment, said surgical micro-instrument 60, 160, 260comprises at least one jointed device 70 and said control instrument 21is suitable to cooperate with said jointed device 70, 170, 270 so that,when in operating conditions, a first movement of said controlinstrument 21 with respect to said detection device 22, corresponds to asecond movement of said jointed device 70, 170, 270.

According to an embodiment, a robotic assembly 100 also comprises

a support 104,

at least one macro-positioning arm 30, connected to said support 104,said macro-positioning arm having a plurality of degrees of freedom,

at least one micro-positioning device 41, 141, 241 having a plurality ofdegrees of freedom of translation.

According to an embodiment, said at least one control device 20 isconnected to at least one portion of said microsurgical robotic assembly100.

According to an embodiment, said at least one control device 20 isfreely positionable with respect to said support 104.

According to an embodiment, said surgical micro-instrument 60, 160, 260comprises at least one micro-instrument sensor, suitable to cooperatewith said detection device 22, such that the position in space of atleast one portion of the surgical micro-instrument 60, 160, 260 can bedetected with respect to said detection device 22.

According to an embodiment, said micro-positioning device 41, 141, 241comprises at least one micro-manipulator sensor, suitable to cooperatewith a detection device 22, such as to detect the position in space ofat least one portion of said micro-positioning device 41, 141, 241 withrespect to said detection device 22.

According to an embodiment, said macro-positioning arm 30 comprises atleast one macro-positioning arm sensor, suitable to cooperate with saiddetection device 22, such as to detect the position in space of at leastone portion of said macro-positioning arm 30 with respect to saiddetection device 22.

According to an embodiment, said microsurgical robotic assembly 100 issuitable to cooperate with a sensor, suitable to detect the position inspace with respect to a single reference system of at least one of: saidposition sensor 28, said tip sensor 29, said macro-positioning armsensor, said micro-positioning device sensor, said micro-instrumentsensor. According to an embodiment, said microsurgical robotic assembly100 is suitable to cooperate with a sensor, suitable to detect theposition in space with respect to a single reference system of at leasttwo of: said position sensor 28, said tip sensor 29, saidmacro-positioning arm sensor, said micro-positioning device sensor, saidmicro-instrument sensor. The provision of this characteristic allows ateleoperation master-slave system to function adequately independentlyof the exact position of said detection device 22, said support 104,said macro-positioning arm 30 and said micro-positioning device 41. Inother words, said medical instrument 60 is able to follow the movementof control instrument 21 with respect to a same common reference systemof coordinates.

According to an embodiment, said at least one surgical micro-instrument60, 160, 260 is connected to said robotic assembly 100 in a detachablefashion.

According to an embodiment, a microsurgical robotic assembly 100 alsocomprises:

-   -   a further control instrument 21, such as to comprise a first        control instrument    -   121 and a second control instrument 221;    -   a further surgical micro-instrument 60, 160, 260 such as to        comprise a first surgical micro-instrument 160 and a second        surgical micro-instrument 260.

According to an embodiment, said first control instrument 121 issuitable to cooperate with said first surgical micro-instrument 160, insuch a way that, when in operating condition, a first movement of saidfirst control instrument 121 with respect to said detection device 22,corresponds to a second movement of said first surgical microinstrument160.

According to an embodiment, said second control instrument 221 issuitable to cooperate with said second surgical micro-instrument 260,such that, when in operating conditions, a first movement of said secondcontrol instrument 221 with respect to said detection device 22,corresponds to a second movement of said surgical micro-instrument 260.

According to an embodiment, said first control instrument 121 issuitable to form the master interface of said robotic assembly 100 forone first hand of the surgeon 200.

According to an embodiment, said second control instrument 221 issuitable to for the master interface of said robotic assembly 100 forone second hand of the surgeon 200, different from said first hand.

According to an embodiment, said first and second control instruments121, 221 are of substantially mirrored in shapes and location, such asto form the master interface of said robotic assembly 100 for both handsof the surgeon. In this way, the interface has improved ergonomics andis more familiar to the surgeon.

According to an embodiment, said control device 20 comprises at leasttwo control instruments 21, 121, 221.

According to an embodiment, said microsurgical robotic assembly 100comprises a further detection device 22 such as to comprise at least twodetection devices.

According to an embodiment, said control device 20 comprises at leasttwo detection devices 22.

According to an embodiment, said microsurgical robotic assembly 100comprises at least one further control device 20, such as to comprise afirst control device 120 and a second control device 220.

According to an embodiment, said first control device 120 is suitable toform the master interface of said robotic assembly 100 for the firsthand of the surgeon 200.

According to an embodiment, said second control device 220 is suitableto form the master interface of said robotic assembly 100 for the secondhand of the surgeon 200, different from said first hand.

According to an embodiment, said first and second control devices 120,220 are of substantially mirrored shapes, such as to form the masterinterface of said robotic assembly 100 for both hands of the surgeon. Inthis way, the interface has improved ergonomics and is more familiar tothe surgeon.

According to one aspect of the invention, a medical instrument 60, 160,260, 360 comprises at least one frame 57 and one jointed device 70.

Said jointed device 70 comprises at least one first joint member 71, orfirst link 71, suitable to connect to at least one portion of said frame57, and at least a second joint member 72, or second link 72.

Said first link 71 is connected via a rotational joint 171 to saidsecond link 72.

Said medical instrument 60 also comprises at least one tendon 90, 190,suitable for moving at least said second link 72 with respect to saidfirst link 71, by pulling it.

At least one of said first link 71, said second link 72 comprises atleast a sliding surface 40, 80, 140, 180, suitable to allow the slidingof at least one portion of said tendon 90, 190 over it.

Said sliding surface 40, 80, 140, 180 is a ruled surface 40, 80,140,180, specifically a ruled surface formed by a plurality of portions ofstraight lines all parallel to each other and substantially parallel toa joint axis of movement P-P, Y-Y.

According to an embodiment, said sliding surface 40, 80, 140, 180 is aruled surface 40, 80, 140, 180, specifically a ruled surface formed by aplurality of portions of straight lines all parallel to each other andsubstantially parallel to a joint axis of movement P-P, Y-Y of therotational joint 171 closest to said sliding surface 40, 80, 140, 180.According to an embodiment, the closest rotational joint 171 is definedby measuring along the direction of the tendon path T-T.

According to an embodiment, said axes of joint movement can be fixed ormobile with respect to a base reference system.

According to an embodiment, said at least one second link 72 is a wristmember 78, and said wrist member 78 comprises at least one slidingsurface 40, 80, 140, 180, formed by a plurality of portions of straightlines parallel to each other and substantially parallel to a first jointaxis of movement.

According to an embodiment, said wrist member 78 comprises at least onejointing portion 172, suitable to form at least one portion of a secondrotational joint 171 having a second joint axis of movement, notparallel to said first joint axis of movement.

According to an embodiment, said first joint axis of movement and saidsecond joint axis of movement are substantially orthogonal to eachother.

According to an embodiment, said first joint axis of movement is a pitchaxis P-P.

According to an embodiment, said second joint axis of joint movement isa yaw axis Y-Y.

According to an embodiment, said medical instrument 60, 160, 260 has atleast one terminal member 77.

According to an embodiment, said terminal member 77 is suitable tocontact with one portion with a patient 201, when in operatingconditions.

According to an embodiment, said terminal member 77 is suitable tohandle a surgical needle 202.

According to an embodiment, said terminal member 77 comprises a cuttingsurface or blade and can act as a scalpel.

According to an embodiment, said terminal member 77 comprises at leastone winding surface 86, made of a plurality of portions of straightlines all parallel to each other and substantially parallel to a jointaxis of movement. According to an embodiment, said winding surface 86 issuitable to allow at least one portion of said tendon 90, 190 to bewound up around it.

According to an embodiment, said second joint member 72 is a terminalmember 77.

According to an embodiment, said jointed device 70, 170, 270 comprises athird joint member 73, suitable to connect to at least said second jointmember 72 by a rotational joint 171.

According to an embodiment, said third joint member 73 is a terminalmember 77.

According to an embodiment, said terminal member 77 is connected to saidwrist member 78 by a rotational joint 171.

According to an embodiment, said at least one joint member 72 is anelbow member 75, and said elbow member 75 comprises a plurality ofsliding surfaces 40, 80, 140, 180 formed by a plurality of portions ofstraight lines all parallel to each other and substantially parallel toa single joint axis of movement.

According to an embodiment, said elbow member 75 comprises at least onejointing portion 172, suitable to form at least one portion of arotational joint 171.

According to an embodiment, said jointed device 70 comprises a thirdjoint member 73, suitable to be connected to at least said second jointmember 72 by a rotational joint 171, in which said second joint member72 is an elbow member 75 and said third joint member 73 is a wristmember 78.

According to an embodiment, said elbow member 75 is connected by arotational joint 171 to said first joint member 71, and in which saidwrist member 78 is connected via a rotational joint 171 to said elbowjoint member 75.

According to an embodiment, said jointed device 70 comprises a fourthjoint member 74, suitable to connect to at least said third joint member73 via a rotational joint 171.

According to an embodiment, said fourth joint member 74 is a terminalmember 77.

According to an embodiment, said terminal member 77 comprises at leastone winding surface 86, formed by a plurality of portions of straightlines all parallel to each other and substantially parallel to a jointaxis of movement, wherein said winding surface 86 is suitable to allowthe winding of at least one portion of said tendon 90, 190 around it.

According to an embodiment, said jointed device 70 comprises said firstmember 71, connected to said wrist member 78 via a rotational joint 171,connected to said terminal member 77 via a rotational joint 171.

According to an embodiment, said jointed device 70 comprises said firstmember 71, connected to said elbow member 75 by a rotational joint 171,connected to said wrist member 78 by a rotation joint 171, itselfconnected to said terminal member 77 by a rotational joint 171. Itshould be apparent to those skilled in the art that making use of jointmembers similar to 71, 72, 73, a jointed device 70 can be assembled toinclude a serial sequence of members, of which from zero to a pluralityof elbow joint members 75, a plurality of, preferably orthogonal, pairsof wrist joint members 78 and at least one terminal joint member 77.

According to an embodiment, said winding surface 86 is a ruled surface.

According to an embodiment, said winding surface is substantiallyunsuitable for said tendon 90, 190 to slide over it. This is becausesaid tendon 90, 190 terminates close to said winding surface 86, on thejoint member that comprises said winding surface 86.

According to an embodiment, said medical instrument 60 comprises atleast one pair of tendons comprising one tendon 90 and one oppositetendon 190, and said tendon 90 and said opposite tendon 190 are suitableto connect their second termination endpoints 92, or second tendontermination 92, to respective tendon fastening points 82, or point oftendon termination 82, of said second joint member 72, such as to movesaid second joint member 72 around its joint axis in oppositedirections.

According to an embodiment, said medical instrument 60 which comprisesat least one pair of tendons comprising one tendon 90 and one oppositetendon 190, and said tendon 90 and said opposite tendon 190 are suitableto connect in their second termination endpoints 92 to respective tendonfastening points 82, or tendon termination features 82, of said terminalmember 77, such as to move it around its joint axis in oppositedirections.

The provision of such a feature makes sure that said tendon 90 and saidopposite tendon 190 can work in an antagonistic fashion, for exampleboth said tendon 90 and said opposite tendon 190 move said terminalmember around the yaw axis Y-Y. Hence, no passive or free joint movementcan occur, and instead there are only positively guided and controlledmovements.

According to an embodiment, said tendon 90 and opposite tendon 190 aresuitable to connect by means of their second termination endpoints 92 torespective tendon fastening points 82, or tendon termination features82, of at least one of said first, second, third and fourth jointmembers 71, 72, 73, 74.

According to an embodiment, said tendon 90 and opposite tendon 190 aresuitable to connect by means of their second termination endpoints 92 inrespective tendon fastening points 82, or tendon termination feature 82,of at least one of said elbow member 75, wrist member 78 and terminalmember 77.

According to an embodiment, said medical instrument 60 comprises atleast one shaft 65, suitable to guide said at least one tendon 90, 190.Said shaft 65 is a shaft according to one of any of the previouslydescribed embodiments.

According to an embodiment, said shaft 65 has a substantially circularsection and has a diameter smaller than 4 millimeters. This allowsextreme miniaturization of the medical instrument.

According to an embodiment, said shaft 65 comprises a longitudinal holesuch as to allow the passage of said at least one tendon 90, 190 insideit.

According to an embodiment, said shaft 65 is integral to said frame 57.

According to an embodiment, said jointed device 70 has a longitudinalextension smaller than 10 millimeters.

According to an embodiment, said jointed device 70 has a volume inferiorto 10 cubic millimeters.

According to an embodiment, said terminal member 77 comprises at leastone first portion of terminal member 177 and at least a second portionof terminal member 277. According to an embodiment, said first portionof terminal member 177 and said second portion of terminal member 277are mobile with respect to each other around a joint axis of movementsuch as to determine a grasping or cutting movement. According to anembodiment, said joint axis of movement is said yaw axis Y-Y.

According to an embodiment, said medical instrument 60, which comprisesat least one pair of tendons, comprises a tendon 90 and an oppositetendon 190, in which one of said tendon 90 and said opposite tendon 190is suitable to connect by means of its second endpoint 92 to arespective tendon fastening point 82, or tendon termination feature 82,p on said first terminal member 177, and in which the other one of saidtendon 90 and said opposite tendon 190 is suitable to connect by meansof its second endpoint 92 to a respective tendon fastening point 82, ortendon termination feature 82, on said second terminal member 277, suchas to move said first portion of terminal member 177 and said secondportion of terminal member 277 with movements in opposite directions.

According to an embodiment, each of said first portion of terminalmember 177 and said second portion of terminal member 277 comprise atleast one winding surface 86.

According to an embodiment, said medical instrument 60 comprises atleast one pair of tendons comprising one tendon 90 and one oppositetendon 190, in which said tendon 90 and said opposite tendon 190 aresuitable to connect by means of their second endpoints 92 in respectivetendon fastening points 82, or tendon termination feature 82, of saidterminal member 77, such as to move said third joint member 73 withrespect to said fourth joint member 74 such as to determine a graspingor cutting movement.

According to an embodiment, said tendon 90 and said opposite tendon 190wind their distal portions around at least one portion of said at leastone winding surface 86 of terminal member 77.

According to an embodiment, said sliding surface 40, 80, 140, 180 is alateral sliding surface 40, 140 suitable to extend away from the centervolume of said jointed device 70, 170, 270 such as to determine that atleast one portion of tendon is deflected away and runs not in contactwith said jointed device 70.

According to an embodiment, said lateral sliding surface 40, 140 joins asurface of the member on which it is built, with at least a continuitysurface 64, sharing a local tangent plane. According to an embodiment,said lateral sliding surface 40, 140 forms at least one sharp edge 63with the member on which it is built.

According to an embodiment, said lateral sliding surface 40, 140 joins asurface of the member on which it is built with a continuity surface 64on one side and on the other side forms one sharp edge 63 with themember on which it is built.

According to an embodiment, said sliding surface 40, 80, 140, 180 is ajoint sliding surface 80, 180 that at least partially surrounds an axisof joint movement. According to an embodiment, said sliding surface 40,80, 140, 180 is a joint sliding surface 80, 180 that at least partiallysurrounds at least one of said pitch axis P-P and said yaw axis Y-Y, andin which said joint sliding surface 80, 180 is oriented opposite withrespect to at least one of said pitch axis P-P and said yaw axis Y-Y,such as to allow at least one intersection between the tendon path T-Tof said tendon 90 and the tendon path T-T of said opposite tendon 190.In other words, said joint sliding surface 80, 180 is not suitable toface towards said joint axis of movement of the closest rotational joint171, when in operating conditions.

According to an embodiment, said joint sliding surface is convex andpartially surrounds at least one of said pitch axis P-P or yaw axis Y-Y,such as to permit at least one intersection of two opposite tendons onitself.

According to an embodiment, the term “closest joint” refers to therotational joint 141 that is closest in distance to the sliding surface40, 80, 140, 180 along the tendon path T-T.

According to an embodiment, on said joint sliding surface 80, 180 thetendon path T-T of said tendon 90 and the tendon path T-T of saidopposite tendon 190, although they do not intersect, they at leastpartially overlap in a projection plane orthogonal to the direction ofsaid axis of joint movement of the closest rotational joint 171.

According to an embodiment, on said joint sliding surface 80, 180 thetendon path T-T of said tendon 90 and the tendon path T-T of saidopposite tendon 190 are distinct from each other and parallel on aprojection plane parallel to the joint axis of movement of the closestrotational joint 171.

According to an embodiment, the tendon path T-T of said tendon 90overlaps with the tendon path T-T of said opposite tendon 190 at leaston a projection plane orthogonal to the direction of said joint axis ofmovement of the closest joint. According to an embodiment, the tendonpath T-T of said tendon 90 is substantially parallel to the tendon pathT-T of said opposite tendon 190 on a projection plane parallel to saidjoint axis of movement of the closest rotational joint.

According to an embodiment, the tendon path T-T of each tendon 90 aresubstantially parallel to each other, on a projection plane parallel tothe said joint axis of movement of the closest rotational joint 171.

According to an embodiment, each tendon path T-T is substantiallystationary over the joint member that it contacts. In other words, evenwhen the tendon 90 is sliding, the overall tendon path T-T issubstantially always in the same position with respect to the jointmember of said medical instrument 60, which it contacts.

Such a feature is uniquely realized by provisioning that said slidingsurface 40, 80, 140, 180 of said winding surfaces 86 has a cooperativegeometrical relationship with said tendon termination feature 82, whichis in turn fittingly positioned on a portion of said medical instrument.

According to an embodiment, said tendon path T-T remains substantiallystationary over the joint member that it contacts for both tendon 90 andopposite tendon 190 that determines opposite joint movements.

According to an embodiment, the tendon path T-T of each tendon 90 issubstantially stationary in its section over said frame 57, except forsaid deflectable portion 93. Said deflectable portion 93 is in factsuitable to be deflected by the pusher assembly 94, not unlike a guitarstring.

According to an embodiment, said at least one tendon 90, 190, when inoperating conditions, follows a tendon path T-T that is entirelycomposed of successive straight in-flight sections 9, which are not incontact with any sliding surface 40, 80 or winding surfaces 86, andcurved sections which are in contact with sliding surfaces 40, 80 orwinding surfaces 86 of the joint members 71, 72, 73, 74, 75, 77, 78.

According to an embodiment, said at least one tendon 90, 190 describes apath around said first joint member 71, such as to at least partiallywind itself over said joint sliding surface 40, 140 of said first jointmember 71.

According to an embodiment, said at least one tendon 90, 190 describes apath around said distal second joint member 72, such as to at leastpartially wind itself over said joint sliding surface 80, 180 of saidsecond joint member 72.

According to an embodiment, said medical instrument 60 comprises aplurality of tendons.

According to an embodiment, the projections of said tendon path T-T ofsaid tendon 90 and of said tendon path T-T of said opposite tendon 190on a plane orthogonal to said joint axis of movement of the closestrotational joint 171 overlap at least at a point of intersection 16,

According to an embodiment, a said in-flight segment 9 of said tendonpath T-T of said tendon 90 is substantially parallel to at least onesaid in-flight segment 9 of said opposite tendon 190.

According to an embodiment, the tendon paths T-T of each tendon 90 aresubstantially parallel to each other, on a projection plane parallel tothe direction of said joint axis of joint movement of the closestrotational joint 171.

According to an embodiment, each said tendon termination feature 82 ispositioned such as to support each tendon 90, 190 so as to keep itstendon path T-T substantially orthogonal to the joint axis of movementof the closest rotational joint 171, such as to allow said tendon 90 toslide on said at least one sliding surface 40, 80 following a tendonpath T-T substantially parallel to the tendon path T-T of any othertendon.

According to an embodiment, each tendon termination feature 82 ispositioned such as to support each tendon 90, 190 such that its tendonpath T-T is stationary with respect to the joint member closest to it.

According to an embodiment, said tendon termination feature 82 ispositioned such as to maintain its tendon path T-T of each tendon 90substantially always in contact with said winding surface 86, when inoperating conditions.

According to an embodiment, said tendon termination feature 82 ispositioned such that the tendon path T-T of each tendon 90, 190 does notenter in contact with the tendon path T-T of any other tendon 90, 190,when in operating conditions.

According to an embodiment, said tendon termination feature 82 ispositioned such that each tendon 90, when in operating conditions,slides on at least one sliding surface 40, 80, describing a curvedsection of the tendon path T-T substantially parallel to the curvedsection of the tendon path T-T described by any other tendon 90, 190when it slides on the same sliding surface 40, 80.

According to an embodiment, said medical instrument 60 is a surgicalinstrument, suitable to be applied in at least one of the followingfields: microsurgery, minimally invasive surgery and laparoscopicsurgery.

According to an embodiment, said medical instrument 60 is suitable forbeing used for a biopsy. According to an embodiment, said medicalinstrument 60 is suitable to be used for an endoscopic procedure.

According to an embodiment, said tendon 90, 190 has a substantiallycircular cross section. According to an embodiment, the diameter of saidtendon 90, 190 is variable in different portions of said tendon 90, 190.According to an embodiment, the mechanical properties of said tendon 90,190 are variable in different portions of said tendon 90, 190. Accordingto an embodiment, said tendon 90, 190 is obtained by joining portions oftendons with different characteristics. According to an embodiment, thecomposition of said tendon 90, 190 is variable in different portions ofsaid tendon 90, 190.

According to an embodiment, said tendon path T-T in at least one portionof the tendon is substantially locally orthogonal to the generatrices ofthe sliding surface 40, 80, 140, 180 on which the tendon slides, inevery operating condition, that is for any rotational angle of therotational joints 171. These characteristics contribute to avoiding thatsaid tendon path T-T of each of said tendons is ever deflected, that isto say that it never bends in a direction parallel to the axis of jointmovement of the closest rotational joint 171.

According to an embodiment, said tendon path T-T is substantiallylocally orthogonal to the generatrices of the sliding surfaces 40, 80,140, 180 on which it slides.

According to an embodiment, said jointed device 70 is primarilyfabricated from metallic materials.

According to an embodiment, said joint members are suitable to bepolished with the aim of further reducing the friction generated by thesliding of said at least one tendon, when said tendon slides over it.

According to one aspect of the invention, a tendon drive system 50 for amedical instrument 60, 160, 260 comprises at least one pusher assembly94.

Said medical instrument 60, 160, 260 comprises a frame 57 and at leastone tendon 90, 190, exclusively suitable to work under tensile loadsapplied at its endpoints, in which a tendon direction T-T is defined, ora tendon path T-T, substantially coinciding with the direction oflongitudinal development of said tendon 90, and in which said tendon 90is fastened at its first endpoint 91, or proximal tendon endpoint 91, orfirst tendon termination 91, to said frame 57.

Said pusher assembly 94 is suitable to apply a force over at least oneportion of said deflectable portion 93 of said tendon 90 along a pushingdirection transversal to the tendon path T-T such as to deflect thetendon path T-T and induce an increased tensile load in said tendon 90.

When said pusher assembly pushes in said pushing direction, transversalto the tendon path T-T, it tends to lengthen locally, only locally, saidtendon path. Such a localized path lengthening, which create a larger,local tendon loop is directly related to the amount of advancement ofthe pusher assembly. The creation of such a larger local tendon loopresults at the opposite end of the tendon, in a proportional moving backof the distal endpoint of the tendon 92 which is fastened to the tendontermination feature 82 on the joint member and hence results in amovement of the joint member.

According to an embodiment, said pusher assembly 94 acts as a unilateralconstraint for said tendon 90.

According to an embodiment, said pusher assembly 94 lengthens orshortens said tendon path T-T in at least one section of said tendonpath T-T, which is substantially straight.

According to an embodiment, said pusher assembly 94 is suitable toretrieve a determined length of said tendon 90. According to anembodiment, said pusher assembly 94 is suitable to release a determinedlength of said tendon 90.

According to an embodiment, said pusher assembly 94 is suitable toretreat on said tendon deflectable portion 93 of said tendon 90, in adirection transversal to the tendon path T-T such that the deflection ofsaid tendon path T-T is decreased and the strain in said tendon 90 isdecreased. In this way, a controlled movement of at least one portion ofsaid jointed device 70 of said medical instrument 60 is allowed.

The terms “retreat” and “retrieve” mean that the pusher assembly, whenpushing in said pushing direction, which is transversal to the tendonpath T-T, locally and only locally, shortens the tendon path. Such alocal shortening creates an increasingly smaller local loop, which isdirectly related to the amount of pulling back of the pusher assembly,and at the opposite end of the tendon, where it is fastened at itsdistal endpoint 92 to the joint member on which it acts, it allows amoving away of said distal endpoint, and hence enables the movement ofsaid joint member.

According to an embodiment, said tendon 90 and opposite tendon 190 havelengths that result in said jointed device 70 of said medical instrument60 being held in a reference position when said tendon 90 and saidopposite tendon 90 are tensioned by the respective tensioning elements99, 199.

According to an embodiment, said frame 57 comprises at least one shaft65, in which a longitudinal shaft direction X-X is defined, saiddirection coinciding or being parallel to the axis of longitudinaldevelopment of said shaft 65.

According to an embodiment, said tendon 90 comprises at least onelongitudinal tendon portion 19, in which the tendon path T-T issubstantially parallel to the longitudinal direction of the shaft X-X,determining a movement of at least said longitudinal portion of tendon19 with respect to said shaft 65, at least along the shaft directionX-X.

According to an embodiment, said pushing direction is parallel to thelongitudinal direction of the shaft X-X.

According to an embodiment, said pushing direction is orthogonal to thelongitudinal direction of the shaft X-X.

According to an embodiment, said tendon 90 is pretensioned. In this way,when said pusher assembly 90 stops exercising its pushing action on saidtendon deflectable portion 93, said tendon 90 remains substantiallyunder tension. The provision of a pretensioned tendon allows a simplecalibration of said tendon drive system 50, making it possible toarbitrarily decide in which pose of the jointed device to position azero pushing action pose.

According to an embodiment, said pusher assembly 94 always applies aminimum positive tension on tendon 90. In this way, as said pusherassembly contacts said tendon deflectable portion 93, said tendon 90remain substantially always under tension. Provisioning a pretensionedtendon allows for the efficient control of the tendon path within themedical instrument 60, under any operating conditions.

According to an embodiment, said tendon 90 also comprises a secondtendon endpoint 92, or distal tendon endpoint 92, suitable to pull amobile element, which can be connected to said second distal tendonendpoint 92.

According to an embodiment, following said tendon along its tendon pathT-T one first encounters said first tendon endpoint 91, then said atleast tendon deflectable portion 93, and then said second tendonendpoint 92.

According to an embodiment, said mobile element is at least one portionof said medical instrument 60, 160, 260, which is mobile with respect tosaid frame 57.

According to an embodiment, when said tendon deflectable portion 93 isdeflected by said pusher assembly 94, said tendon 90 determines themovement of at least one portion of said jointed device 70 with respectto said frame 57.

According to an embodiment, said pusher assembly 94 comprises at leastone pushing element 95, mobile with respect to said frame 57 andsuitable to push a plunger 96, such that said plunger 96 pushes on atleast one tendon deflectable portion 93 of said tendon 90.

According to an embodiment, at least one body is placed between saidpushing element 95 and said plunger 96. According to an embodiment, saidpushing element 95 is in contact with said plunger. In other words, saidat least one pushing element 95 is suitable to push directly orindirectly on said plunger 96.

According to an embodiment, said pushing element 95 is mobile withrespect to said plunger 96 within a contacting position, in which saidpushing element 95 is suitable to exercise a pushing action on saidplunger 96, and a non-contacting position, in which said pushing element95 is disconnected from said plunger 96, and it is not suitable toexercise any pushing action on said plunger 96. According to anembodiment, in said contacting position said pushing element 95 is notnecessarily in contact with said plunger 96. In other words, accordingto an embodiment, said pushing element 95 exercises a pushing action viaat least one intermediate body placed between said pushing element 95and said plunger 96.

According to an embodiment, said pusher assembly 94 also comprises atleast one sterile barrier 87, suitable to substantially impede mutualbacterial contamination of the two environments it separates.

According to an embodiment, said sterile barrier 87 is placed betweensaid pushing element 95 and said plunger 96.

According to an embodiment, said sterile barrier is of a form andmaterial suitable to transmit the push of said pushing element 95 tosaid plunger 96.

According to an embodiment, said pushing element 95 is mobile withrespect to said frame 57 along a substantially linear trajectory.

According to an embodiment, said pushing element 95 is a piston.

According to an embodiment, said drive system 50 comprises at least twotendon guiding elements 97, or guiding pulleys, positioned along saidtendon direction T-T such that when said pusher assembly determines adeflection of said tendon path T-T, said at least said two tendonguiding elements 97 cooperate to confine the deflection of said tendonpath T-T to the tendon path section between said two guiding elements97.

According to an embodiment, said plunger 96 comprises at least oneplunger idle pulley 98, suitable to push on said tendon deflectableportion 93, and in which said plunger idle pulley 98 is suitable tofreely turn around its axis, and in this way to reduce the slidingfriction over said tendon deflectable portion 93 at least when pushed bysaid plunger 96.

According to an embodiment, said plunger idle pulley 98 is a ballbearing.

According to an embodiment, said second tendon endpoint 92 is a boss ora loop or a knot.

According to an embodiment, said tendon 90 is suitable to bepretensioned.

According to an embodiment, said tendon drive system 50 comprises atleast one pretensioning element 99, suitable for maintaining said tendon90 pretensioned.

According to an embodiment, said pretensioning element 99 is a spring,suitable to apply a force between the frame 57 and the plunger 96, toimpose a preload on said tendon 90 that is substantially proportional tothe compression movement of said spring 99.

According to an embodiment, said pusher assembly 94 comprises anelectric motor, suitable to move said pushing element 95.

According to an embodiment, said pusher assembly 94 comprises a leadscrew and nut type actuator. According to an embodiment, said actuatorcomprises a ball screw.

According to an embodiment, said tendon 90 is at least partially made ofa material that is softer than the materials of the surfaces over whichit slides. In other words, said tendon 90 is at least partially made ofmaterial that is less hard than the surface over which it slides.

According to an embodiment, said tendon 90 is at least partially made ofpolymeric material. The provision of a tendon made at least partially ofpolymeric material allows a reduction in wear of the surfaces over whichit slides, with respect to a tendon made of metal, for example.

According to one variant of an embodiment, said first tendon endpoint91, is fastened to said plunger 96, instead than to said frame 57.

According to an embodiment, said tendon drive system 50 comprises atleast one further tendon 190, or opposite tendon 190, opposed to saidtendon 90 and fastened or constrained in its first endpoint 91, orproximal endpoint, to said frame 57, said tendon 190 extending along thetendon direction T-T, or tendon path T-T.

According to an embodiment, said tendon drive system 50 comprises atleast one further pusher assembly 94, or opposite pusher assembly 194,opposed to said pusher assembly 94 and suitable to push on at least oneportion of tendon deflectable portion 93 of said opposite tendon 190,along a transversal pushing direction of tendon T-T such as to deflectthe tendon path T-T and to induce an increased tensile load in saidopposite tendon 190 and said tendon 90. In other words, said tendon 90and said opposite tendon are suitable to work opposed to each other likeantagonistic muscles of the human body that cooperate to determine theadduction and abduction movements of a joint.

According to an embodiment, said opposite pusher assembly 194 pushes onsaid tendon deflectable portion 93 of said opposite tendon 190 along apushing direction transversal to said tendon path T-T, deflecting saidtendon path T-T, inducing tensile load in said opposite tendon 190, fromits proximal portion 18 and inducing tensile load in said tendon 90,from its distal portion 19.

According to an embodiment, said tendon 90 and said tendon 190 aredistally structurally connected by a junction between said tendon andsaid opposite tendon. According to an embodiment, said tendon and saidopposite tendon are both distally structurally connected to a commonjunction element, such that the transmission of the force by said tendonto said opposite tendon is guaranteed.

According to an embodiment, said opposite tendon 190 comprises a secondendpoint 92, or distal endpoint 92, suitable to pull a mobile elementassociable to said second tendon endpoint 92 of said opposite tendon190.

According to an embodiment, said opposite tendon 190 comprises a secondendpoint 92, or distal endpoint suitable to pull a common, single mobileelement, associable to both said second tendon endpoint 92 of saidtendon 90 and said second tendon endpoint 92 of said opposite tendon190. According to an embodiment, said tendon 90 and said opposite tendon190 have lengths such that said common, single mobile element is in areference position when said tendon 90 and said opposite tendon 190 arepretensioned by their respective pretensioning elements.

According to an embodiment, said tendon 90 and said opposite tendon 190are two portions of a single tendon 90.

According to an embodiment, said second tendon endpoint 92 of saidtendon 90 and said second endpoint 92 of said opposite tendon 190coincide and are suitable for pulling a common mobile element, which canbe associated both to said second endpoint 92 of said tendon 90 and tosaid second tendon endpoint 92 of said opposite tendon 190.

According to an embodiment, said opposite tendon 190 comprises at leasta longitudinal portion 19, in which the tendon path T-T is substantiallyparallel to the longitudinal direction of the shaft X-X, such as to moveat least said longitudinal portion 19 of said opposite tendon 190 withrespect to said shaft 65, at least along the longitudinal direction ofthe shaft X-X.

According to an embodiment, said tendon drive system 50 comprises atleast a pair of tendons 90, 190 for each degree of freedom, in whichsaid tendon pair comprises a tendon 90 and an opposite tendon 190.

According to an embodiment, said tendon 90 and said opposite tendon 190are suitable to be pulled simultaneously, such that the forcetransmitted to the common mobile element by both said tendon 90 and saidopposite tendon 190 is the sum of the force transmitted by said tendon90 and said opposite tendon 190.

According to an embodiment, said tendon 90 and said opposite tendon 190are suitable to be simultaneously pulled with substantially the sameamount of force.

According to an embodiment, said tendon 90 and said opposite tendon 190are suitable to be pulled with a force on one of them higher than on theother.

According to an embodiment, said tendon 90 and said opposite tendon 190are suitable to be simultaneously pulled, retrieving substantially thesame tendon length from their proximal portion.

According to an embodiment, said tendon 90 is suitable to be pulled,retrieving a first tendon length from its proximal section andsimultaneously said opposite tendon 190 is suitable to be released byits proximal portion, releasing a second tendon length from the oppositetendon, substantially equal to said first tendon length.

According to an embodiment, said tendon drive system 50 comprises anopposite

pretensioning element 199, suitable for maintaining said opposite tendon190 pretensioned.

According to an embodiment, said opposite pretensioning element 199 is aspring 99.

According to an embodiment, said pretensioning element 99 and saidopposite pretensioning element 199 are suitable to cooperate tosimultaneously maintain said tendon 90 and said opposite tendon 190pretensioned, so that the pusher assembly 94 and said opposite pusherassembly 194 can work at the same time.

The provision that said pretensioning element 99 and said oppositepretensioning element 199 allows said tendon 90 and said opposite tendon190 to be kept in their pretensioned state, with a pretension valuesuitable to counterbalance the weight of said common mobile elementattached to them. In this way, the gravitational force has no role inthe drive system.

According to an embodiment, said tendon 90 and said opposite tendon 190are suitable to connect their second endpoints 92 to their respectivetendon fastening points 82, or tendon termination features 82, to oneof: said second joint member 72 and said terminal member 77, such as tomove it in opposite directions. The cooperation between saidcharacteristic and the provision of said pretensioning element 99 andsaid opposite pretensioning element 199 allows for all movements to bepositively guided and controlled, avoiding any passive or free jointmovements, such as from return springs.

According to an embodiment, said tendon drive system 50 comprises aplurality of tendons 90 and a plurality of opposite tendons 190.

According to an embodiment, said tendon drive system 50 comprises aplurality of pusher assemblies 94 and a plurality of opposite pusherassemblies 194.

According to an embodiment, said plurality of tendons 90 and saidplurality of opposite tendons 190 are positioned on a portion of a drum59, or drum 59, of said frame 57 such that the tendon path T-T of eachtendon 90, 190 runs separate with respect to the path of all othertendons 90, 190.

According to an embodiment, said plurality of tendons 90 and saidplurality of tendons 190 are positioned substantially radially, or asrays, on said drum 59. According to an embodiment, said plurality oftendons 90 and said plurality of opposite tendons 190 are configured onesaid drum 59 like a cylinder of a radial engine, and in which the pathsof said tendon 90 and said opposite tendon 190 do not cross each otheron said drum 59.

According to an embodiment, each tendon 90 of said plurality of tendons90 is suitable to be engaged by its respective pusher assembly 94independently of other tendons 90.

According to an embodiment, said tendon 90 of said plurality of tendons90 is suitable to be engaged by its respective pusher assembly 94independently of an associated opposite tendon 190.

According to an embodiment, a drive system assembly for a medicalinstrument 60, 160, 260 comprises:

at least one tendon drive system 50 according to one of any embodimentspreviously described,

at least one medical instrument 60, 160, 260 comprising at least onejointed device 70, 170, 270 in which said jointed device 70, 170, 270comprises at least one rotational joint.

According to an embodiment, said tendon 90, 190 is fastened orconstrained at its second endpoint 92 to at least a portion of saidjointed device 70, 170, 270 mobile with respect to said frame 57, suchthat said tendon 90, 190 is suitable to pull on at least a portion ofsaid jointed device 70, 170, 270, moving it with respect to said frame57.

According to an embodiment, said tendon 90 and said opposite tendon 190are both fastened to a same portion of said jointed device 70, 170, 270,mobile with respect to said frame 57, in their respective secondendpoints 92, such that said opposite tendon 190 is suitable to pull atleast a portion of said jointed device 70, 170, 270, moving it withrespect to said frame 57 by a movement which is opposite to the movementdetermined by said tendon 90.

According to an embodiment, said drive system assembly comprises atendon pair 90, 190, and said tendon pair comprises a tendon 90 and anopposite tendon 190, for every degree of freedom of movement of saidjointed device 70, 170, 270.

According to an embodiment, when said tendon 90 and said opposite tendon190 are pulled simultaneously and with substantially the same amount offorce, the movement of at least a portion of said jointed device 70,170, 270 of said medical instrument 60, 160, 260 is impeded.

According to an embodiment, when said tendon 90 and said opposite tendon190 are simultaneously pulled with different amounts of force, where oneamount of force is greater than the other, a controlled movement of atleast a portion of said jointed device 70, 170, 270 of said medicalinstrument 60, 160, 260 results.

According to an embodiment, said medical instrument 60, 160, 260 is atleast one of: a surgical instrument, a microsurgical instrument, aninstrument for laparoscopic surgery, an endoscopic instrument, aninstrument for biopsies.

According to one aspect of the invention, a tendon 90, 190 for a medicalinstrument 60, said medical instrument 60 comprising at least onejointed device 70 and one frame 57, is suitable to move at least aportion of said jointed device 70 with respect to said frame 57.

Said jointed device 70 has at least on degree of freedom of movementwith respect to said frame 57.

Said tendon 90 is exclusively suitable for working under tensile load.

Said tendon 90 is fabricated in a material that is less hard than thematerial of said jointed device 70.

The provision of this characteristic allows the fabrication of a medicalinstrument 60 comprising a jointed device 70 with greater resistance towear, caused by the sliding of tendon 90 over at least a portion of saidjointed device 70. Furthermore, this characteristic avoids any wear andloss of material of the surface of the jointed device 70 over which thetendon slides. In other words, the provision of this characteristicavoids said jointed device 70 from becoming scratched due to the effectsof the tendon 90 sliding over it, when in operating conditions.

According to an embodiment, said tendon 90 slides over at least oneportion of said jointed device 70, when in operating conditions.

According to an embodiment, said tendon 90 is made of a constructionthat is not suitable for transmitting pushing.

According to an embodiment, said tendon 90 is fabricated of a softermaterial than the material of said jointed device 70.

According to an embodiment, said tendon 90 is fabricated in a polymericmaterial. The provision of a tendon that is at least partiallyfabricated in a polymeric material allows the wear of the surface overwhich it slides to be reduced, with respect to a tendon made of metalfor example, and helps to preserve the geometric tolerances establishedduring the design phase and subsequently prolongs the life of saidtendon 90, 190 as well as the life of said medical instrument 60, 160,260.

According to an embodiment, said tendon 90, 190 is made of polyethylene.According to an embodiment, said tendon 90, 190 is made of highmolecular weight polyethylene, or UHMWPE. According to an embodiment,said tendon 90, 190 is made of Kevlar. According to an embodiment, saidtendon 90, 190 is made of Vectran. According to an embodiment, saidtendon 90, 190 is made of Zylon, or PBO. According to an embodiment,said tendon 90, 190 is made of a combination of the above materials.

According to an embodiment, said tendon 90, 190 is made of polymerfibers.

According to an embodiment, said jointed device 70 is made of a metallicmaterial.

According to an embodiment, said jointed device 70 is made of at leastone of: INOX steel or stainless steel; super-fast steel; widia; hardenedsteel; tempered steel; titanium.

According to an embodiment, said jointed device 70 is made of a ceramicconductive material.

According to an embodiment, said tendon 90 comprises at least one tendonendpoint 91, suitable to be glued to said frame 57.

According to an embodiment, said tendon 90 is unraveled into strandsaround its first tendon endpoint 91 such as to maximize the gluedsurface.

According to an embodiment, said tendon 90 comprises at least a secondtendon endpoint 92, suitable to connect to at least a portion of saidjointed device 70.

According to an embodiment, said second endpoint 92 is a boss. Accordingto an embodiment, said second tendon endpoint is a loop. According to anembodiment, said second tendon endpoint 92 is a knot.

According to an embodiment, said second tendon endpoint 92 is glued toat least one portion of said jointed device 70.

According to an embodiment, said first tendon endpoint 91 is terminatedby wrapping said tendon around a portion of said medical instrument 60multiple times. According to an embodiment, said second endpoint 92 isterminated by wrapping said tendon around a portion of said medicalinstrument 60 multiple times. According to an embodiment, said tendon iswrapped around with a curvature radius that is substantially equal toits diameter.

According to an embodiment, said tendon 90, 190 has a diameter between0.05 mm and 0.3 mm.

According to an embodiment, said tendon 90, 190 has an elastic modulebetween 50 GPa and 100 GPa.

According to an embodiment, said tendon 90, 190 is fabricated such as tohave a curvature radius inferior or substantially equal to onemillimeter.

According to an embodiment, said tendon 90 is exclusively suitable towork under tensile load applied at the endpoints, avoiding said tendonto be pinched, to be laterally guided in a channel or to comprise asheath.

According to an embodiment, said tendon 90, 190 is suitable to bepre-lengthened with a load cycle comprising at least two loads of anentity equal to at least half of the tensile breaking strength of saidtendon 90, 190.

According to an embodiment, said tendon 90 has a transverse dimension,that is a dimension that is substantially orthogonal with respect tosaid tendon path T-T, variable in different tendon portions.

According to an embodiment, said tendon 90, 190 has a substantiallycircular cross section.

According to an embodiment, the diameter of said tendon 90 is variablein different portions of said tendon 90.

According to an embodiment, said tendon 90 is thinner at said secondtendon endpoint 92. According to an embodiment, said tendon 90 isthicker in said longitudinal portion 19. This way, the tendon 90, 190 issuitable to be more flexible close to or at the tendon fastening point82, as well as being stiffer close to or on the inside of said shaft 65.

According to an embodiment, the mechanical properties of said tendon 90are variable in different portions of said tendon 90.

According to an embodiment, said tendon 90, 190 is obtained by joiningor juxtaposing tendon portions with different characteristics.

According to an embodiment, the composition of said tendon 90, 190 isvariable in different portions of said tendon 90, 190.

According to an embodiment, said tendon 90, 190 has a diameter between0.1 mm and 0.3 mm.

According to an embodiment, said tendon 90 is suitable to cooperate withan opposite tendon 190 to move at least a portion of said jointed device70, 170, 270.

According to an embodiment, when said tendon 90 and said opposite tendon190 are suitable to be simultaneously pulled with one force being largerthan the other, a controlled movement of at least a portion of saidjointed device 70, 170, 270 or said medical instrument 60, 160, 260results.

According to an embodiment, when said tendon 90 and said opposite tendon190 are simultaneously pulled with the same force, the movement of atleast a portion of said jointed device 70 of said medical instrument 60is impeded.

According to an embodiment, a tendon pair 90, 190, in which every paircomprises a tendon 90 and an opposite tendon 190 is foreseen for everydegree of freedom of movement for said jointed device 70.

According to an embodiment, a tendon 90, 190, 191, 192 of a medicalinstrument 60, 160, 260, 360 of a robotic surgical assembly 100 is madeof braided strands, preferably braided polymeric strands. The strands,also called yarns, may have different sizes. Each strand, or yarn, maybe formed of polymeric fibers forming the strand or yarn. Preferably,the polymer of the fibers is UHMWPE. According to an embodiment, thepolymer of the fiber is poly-ethylene (PE). The tendon as well as thestrands may be made of fibers of: PE, UHMWPE, Kevlar, and Vectran.Zylon, or PBO, combination of the above. The fibers forming said strandmay have an elastic modulus up to 150 GPa each fiber. As the fibers aregathered forming said strands and the strands are braided togetherforming said tendon 90, 190, 191, 192, the tendon may have an elasticmodulus equal to or inferior to 130 GPa, or commonly between 50 GPa and100 GPa.

According to an embodiment, the tendon 90, 190, 191, 192 comprises ajacket 90′ and a core 90″, wherein the jacket 90′ is braided. The core90″ may be braided. According to an embodiment the core, 90″ is notbraided.

When both the jacket 90′ and the core 90″ are braided, as shown forexample in FIG. 43, the strands or yarns forming the jacket 90′ arebraided together avoiding being braided with the strands forming thecore 90″. Thereby, the jacket 90′ and the core 90″ are notinter-braided, and are braided independently from each other. That mayallow a local relative movement of the jacket 90′ and the core 90″.Preferably, the number of strands forming the jacket 90′ is greater thanthe number of strands forming the core 90″, when the core 90″ is formedby braided strands.

According to an embodiment, the jacket 90′ is primarily designed toobtain a desired sliding friction, as the jacket 90′ of the tendon 90,190, 191, 192 is designed to slide over a portion of the jointed device70, 170, 270, and preferably over one or more convex, ruled surface 40,80,140, 180 of the links 71, 72 of the jointed device 70, 170, 270.According to an embodiment, the core 90″ is primarily designed to beartensile loads. Preferably, also the braided jacket 90′ contributes tobear tensile loads, thereby cooperating with the core 90″ either braidedor not braided. The braid pitch may differ from jacket 90′ and core 90″.According to an embodiment, the braided jacket pitch is greater than thebraided core pitch. According to an embodiment, the braided jacket pitchis inferior to the braided core pitch.

The jacket is preferably coated with poly-dimethylsiloxane (PDMS),and/or poly-tetrafluoroethylene, (PTFE), and/or other suitable material,such as a resin, to improve wear resistance without impact slidingfriction. PDMS and/or PTFE coating 90′″ may for example also reduce theroughness of the braided tendon, where the roughness results from thepresence of strands braided together and thus increasing tendon wearresistance during sliding.

According to an embodiment, the at least one tendon 90, 190, 191, 192 isrouted around at least some of the links 71, 72, 73, 74, 75, 76, 77, 78of the jointed device 70, 170, 270 and describes a tortuous path at itsdistal portion 92′, and said distal portion 92′ is in contact with andslides on one or more convex, ruled surfaces of said links, while themain longitudinal portion 19 of the tendon 90, 190, 191, 192 receivedwithin the instrument shaft 65 has a substantially straight path.Preferably, the distal portion 92′ of the at least one tendon 90, 190,191, 192 describing said tortuous path while sliding and winding aroundthe one or more convex, contact surfaces 40, 80, 86, 140,180 of thelinks is braided with a higher picks-per-inches (PPI) than thelongitudinal portion 19 of the same tendon 90, 190, 191, 192.

As it is known, “PPI” refers to the number of pics per inch of a braid.

The higher the PPI, the smoother the braid, but according to analysiscarried out by the inventors, too high pic count will generally reducetendon stiffness.

Having higher PPI allows for grater resistance to the flattening, i.e.,transverse squeezing. According to a preferred embodiment, the distalportion 92′ of each tendon describes said tortuous path has a high PPIin range 25-100. According to an embodiment, the longitudinal mainportion 19 of each tendon, describes a substantially straight path, hasa PPI in range 3-25. Preferably, the distal portion 92′ of each tendondescribing said tortuous path has greater resistance to flattening,i.e., transverse squeezing, compared to the tendon main longitudinalportion 19, in order to better manage to describe a tortuous path and toslide on while in contact with said jointed device 70.

The distal portion 92′ of the tendon 90, 190, 191, 192 may have a lengthof 3-5 millimeters. The distal portion 92′ of the tendon 90, 190, 191,192 may have a length which is in range 5%-10% ( 1/20- 1/10) of theentire length of the tendon (i.e. from the proximal endpoint 91 to thedistal endpoint 92). According to an embodiment, the tendon is about 20centimeters long. The distal portion 92′ of the tendon 90, 190, 191, 192may have a length which is about one third (⅓) of the tendon length.

The linear density of the strands forming said tendon 90, 190, 191, 192may be in range 10-55 dTex (i.e., “deciTex”: grams/10 kilometers ratio)and preferably 10-25 dTex.

The tendon 90, 190, 191,192 may not comprise any braided jacket, andtherefore may comprise a braided core 90″, for example a poly-ethylenebraided core, formed by 6-12 braided line strands with PPI in range10-60.

The stiffness of a tendon 90, 190, 191, 192 may vary along itslongitudinal extension. The local PPI and/or the local linear densityand/or the number of braided strands of the jacket and/or of the coremay influence the local stiffness of the tendon. Thereby, by means oftuning the local PPI and/or the local linear density and/or the numberof braided strands of the jacket and/or of the core it is possible toobtain a tendon 90, 190, 191, 192 with the desired localized mechanicalproperties. For example, the local PPI should not be too high because itwould compromise the tensile stiffness of the braided tendon, and shouldnot be too low because it would reduce the resistance to flattening(squeezing) and wear resistance. Flattening may alter the properties ofthe tendon, inter alia sliding friction, because it would cause thecross-section of a circular tendon 90, 190, 191, 192 to become oblongand/or oval, increasing thereby the contact area with the jointed device70. According to the inventors, a good compromise is to get the tendonflattening of an amount which causes the transversal dimension thereofnot exceed twice the circular tendon outer diameter. The jacket may betherefore suitably braided to mechanically contain the tendency towardsflattening of the core.

As shown for example in FIGS. 15E and 15F, the tendon main longitudinalportion 19 of each tendon 90, 190, 191, 192 may have reduced PPI(depicted in light grey) compared to the tendon distal portion 92′(depicted in black) near and at the tendon termination 92. The tendondistal portion 92′ near and at the tendon termination 92 is designed todescribe a tortuous path and to slide while in contact with one or moreconvex, ruled surfaces of the jointed device, at least one of said oneor more convex ruled surfaces being preferably made in single piece witha link 71, 72, 73, 74, 75, 76 of the jointed device 70.

As shown for example in FIG. 44, the tendon main longitudinal portion 19may have reduced PPI compared to the tendon distal portion 92′ near andat the tendon termination 92 designed to have a tortuous path whichslide on a portion of the jointed device 70.

The outer size (diameter) of the braided tendon 90, 190, 191, 192 may beinferior to 0, 5 millimeters, and preferably inferior to 0, 4, and morepreferably equal or inferior to 0, 3.

The distal termination 92 of the tendon 90, 190, 191, 192 is designed totransfer load to the link for actuating the degree of freedom of thejointed device 70. Preferably said distal termination 92 forms a knotformed by the tendon itself, and the distal termination is preferablyheated to strengthen the knot. According to an embodiment, the distaltermination 92 is heated upon the knot has been realized. According toan embodiment, the distal termination 92 is heated upon the knot hasbeen realized and before or while cutting off a tendon segment furtherdistal to the knot. Heating may be obtained with any conventionalmethod, such as laser heating, torch heating or oven, etc. Preferablyheating determines local melt of the jacket 90′ and/or the jacketcoating 90′″ so that at the knot the jacket 90′ and/or the coating 90′″of different tendon segments melt together thereby reducing relativesliding of the tendon segments forming the knot, thus strengthening thetensile resistance of the knot and therefore the ultimate tensilestrength of the tendon 90, 190, 191, 192 as a whole.

Preferably, the braided tendon jacket 90′ has variable PPI, wherein thedistal portion 92′ of the tendon 92 has PPI in range 50-100, while thelongitudinal portion 19 of the same tendon has a lower PPI in the rangeof about 10-20. According to analysis carried out by the inventors, thatallows to reduce overall tendons elongation reaching a desired overallaxial stiffness and an acceptable axial non elastic elongation

A braided tendon may generally undergo to non-elastic assessment when atensile load is applied, therefore this tendon 90, 190, 191, 192 ispreferably pre-loaded with load pre-stretch cycles, with the aim to makepredictable the non-elastic deformation of the tendon when in operativeconditions thus simplifying the control, i.e., numerical control, of therobotic surgical assembly 100. The pre-stretch load may be of about halfof the ultimate tensile strength of the tendon 90, 190, 191, 192.

A relatively high PPI of the jacket allows to compress the core wherethe tendon 90, 190, 191,192 bends (i.e. at distal portion 92′ of thetendon 90, 190, 191,192) and that allows the tendon 90, 190, 191,192 forhaving substantially circular cross-section avoiding to have an oblongoval cross-section in operative conditions. The term “circularcross-section” used herein is obviously a simplification because thetendon, as per being composed of braided yarns, will have irregularcontours in a given cross-section, and with the term “circular” as usedherein it is indicated also this peculiar contour shape. Preferably, theterm “diameter” used herein also means a cross-section profile of thebraided tendon, which is not perfectly circular because thecross-section of the braid may locally depart from an ideal circle.

Preferably, the tendon core 90″ may be formed by a single strand ofhigher linear density or multiple strands with lower linear density, andthe jacket 90′ may have strands with lower linear density compared tothe tendon core 90″, but in higher number and said strands of the tendonjacket 90′ may be braided with higher PPI. A relatively high PPI of thejacket 90′ allows to compress the core 90″ where the tendon 90, 190,191, 192 bends (i.e., at the distal portion 92′ thereof) and at the sametime allows to satisfactory cover the core 90″ avoiding to expose thecore 90″ thus avoiding to force the core 90″ to slide over the medicalinstrument 60, 160, 260, 360. According to an embodiment, each of thestrands composing the braided jacket 90′ has linear density in range 10to 25 dTex.

In the following, a driving method for a robotic assembly 100 isdescribed.

A driving method of a surgical robotic assembly comprises the followingphases:

-   -   provide a robotic assembly 100 according to one of any of the        embodiments previously described.    -   employ at least a vision system associable to the robotic        assembly 100 for the visualization of at least a portion of the        patient 201.    -   position said macro-positioning arm 30, such that the work        volume 7, reached by at least a portion of said terminal portion        77 is within the field of view of said at least one vision        system 103 associable to said robotic assembly 100;    -   drive at least one micro-positioning device 41, 141,241, 341;    -   drive at least one jointed device 70, 170, 270 of a medical        instrument 60, 160, 260, 360.

According to one possible operating mode, a driving method of a surgicalrobotic assembly comprises at least one of the following further phases,listed in a preferred, but not necessary order:

-   -   release said macro-positioning arm 30 so as to be able to drag        it.    -   position said macro-positioning arm 30, so that the work volume        7 reached by said at least one terminal portion 77 is within the        vision field of said at least one vision system 103, associable        to said robotic assembly 100;    -   lock said macro-positioning arm 30;    -   drive said at least one micro-positioning device 41, 141, 241 by        means of said at least one control device 20;    -   drive said at least one jointed device 70, 170, 270 of the        medical instruments 60, 160, 260 by means of said control device        20.

A control method for a control device for microsurgery for amicrosurgical robotic assembly is described below.

A control method for a control device for microsurgery for amicrosurgical robotic assembly comprises the following phase, listed ina preferred but not necessary order.

-   -   provide at least one microsurgical control device 20 according        to one of any of the embodiments previously described;    -   manipulate said control instrument 21;    -   move at least on portion of said control instrument 21 with        respect to said detection device 22.

According to one possible operating mode, one method comprises at leastone of the following further phases:

-   -   provide a microsurgical robotic assembly 100 according to one of        the embodiments previously described;    -   move said surgical micro-instrument 60, 160, 260 by said control        instrument 21;    -   move said micro-positioning device 41, 141, 241 by means of said        control instrument 21;    -   use a microscope 103 associable to said robotic assembly 100 to        visualize at least one portion of a patient 201;    -   activate a teleoperation condition, or mode, according to which        a movement of the control instrument 21 in a first direction,        with respect to a coordinate system associated to at least one        of said detection device 22 and said microscope 103, corresponds        to a movement of said surgical micro-instrument 60, 160,260 in        the same direction with respect to said coordinate system.

According to an embodiment, said portion of the patient 201 is comprisedin said work volume 7.

According to one possible operating mode, a method comprises thefollowing further phases:

-   -   provide a further control device 20 such as to comprise a first        control device 120 and a second control device 220;    -   manipulate said first control device 120 with one first hand;    -   manipulate said second control device 220 with a second hand.

According to one possible operating mode, one method comprises thefollowing further phases:

-   -   provide a further control instrument 21, such as to comprise a        first control instrument 121 and a second control instrument        221;    -   manipulate said first control instrument 121 with one hand;    -   manipulate said second control instrument 221 with the other        hand.

According to an embodiment, said joint members 71, 72, 73, 74 areobtained by wire electro-discharge machining.

According to an embodiment, said joint members 71, 72, 73, 74 areobtained by micro-injection molding.

According to an embodiment, said joint members 71, 72, 73, 74 areobtained by 3D printing.

A method for the fabrication of said medical instrument 60, 160, 260 isdescribed below.

According to one possible operating mode, a fabrication method for themedical instrument 60, 160, 260 comprises a phase of fabrication of amedical instrument 60, 160, 260 according to one of any embodimentspreviously described, by at least one additive manufacturing technique.

According to one possible operating mode, a fabrication method of amedical instrument 60, 160, 260 comprises a phase of fabrication amedical instrument by micro-injection molding. In other words, afabrication method for the medical instrument 60, 160, 260 comprises aphase of fabrication of a medical instrument by means of micromolding.

A driving method of a tendon 90, 190 for a medical instrument 60, 160,260 is described below.

A driving method of a tendon 90 for a medical instrument 60, 160, 260comprises the following phases, listed in a preferred, but not necessaryorder of execution:

-   -   A′) provide a tendon drive system 50 according to one of any of        the previously described embodiments;    -   B′) push at least on a portion of said tendon 90, 190 such as to        deflect its tendon path T-T;    -   C′) generate a tensile load in said tendon 90, 190.

According to one possible operating mode, a method comprises the furtherphase of providing a drive system assembly according to one of any ofthe embodiments previously described.

According to one possible operating mode, one method comprises at leastone of the following further phases:

-   -   D′) pretension said tendon 90 before phase B;    -   E′) drive said pusher assembly 94 before phase B and after phase        D;    -   F′) after phase C, move at least one portion of said jointed        device 70, 170, 270 of said medical instrument 60, 160, 260;    -   G′) after phase F′), drive said opposite pusher assembly 194;    -   H′) after phase G′), move said at least one portion of said        jointed device 70, 170, 170 of said medical instrument 60, 160,        260 of phase F′) in an opposite direction.

According to one possible operating mode, one method comprises thefurther phases of:

-   -   I′) simultaneously drive said pusher assembly 94 and said        opposite pusher assembly 194.    -   J′) pull said tendon 90 and said opposite tendon 190 with        differing amount of forces, force on one being greater than on        the other;    -   K′) move at least one portion of said jointed device 70, 170,        270 of said medical instrument 60, 160, 260 by a controlled        movement.

According to one possible operating mode, a method comprises the furtherphases of:

-   -   L′) instead of phase J′), pull said tendon 90 and said tendon        190 with substantially the same amount of force;    -   M′) instead of phase K′), impede the movement of at least a        portion of said jointed device 70, 170, 270 of said medical        instrument 60, 160, 260.

According to one possible operating mode, one method comprises thefollowing phases instead of the phases I′), J′), K′):

-   -   N′) drive simultaneously said pusher assembly 94 and said        opposite pusher assembly 194;    -   O′) simultaneously pull said tendon (90) to retrieve a first        tendon length from its proximal portion and release said        opposite tendon (190) by its proximal portion releasing a second        length of the opposite tendon, substantially equal to the first        tendon length,    -   P′) move at least one portion of said jointed device 70, 170,        270 of said medical instrument (60, 160, 260) by a controlled        movement in relationship to said tendon length and opposite        tendon length.

According to one possible operating mode, one method comprises thefurther phases of:

-   -   drive said opposite tendon 190 by means of said opposite pusher        assembly 194;    -   move at least a portion of said medical instrument 60, 160, 260        by means of said pusher assembly 94.

A method to replace a tendon 90, 190 for a medical instrument isdescribed below.

According to one possible operating mode, a method for replacing atendon 90, 190 comprises the following phases:

-   -   provide a further tendon 90, 190 according to any of the        embodiments previously described;    -   A″) detach said tendon 90, 190 from said medical instrument 60;    -   B″) mount said further tendon 90, 190 on said medical instrument        60.

According to one possible operating mode, the tendon 90 is attachedfirst at said second tendon endpoint 92 and then at said first tendonendpoint 91.

According to one operating mode, a method comprises the followingfurther phases:

-   -   C″) before the phase A″), lock said plunger (96), in a position        suitable to eliminate any pretension on the associated tendon        90.

According to an embodiment, said plunger (96) is locked by the use of apin inserted in the plunger locking hole 48.

According to one possible operating mode, one method comprises thefollowing further phases:

-   -   D″) between the phase A″) and the phase B″), clean said medical        instrument 60.

According to one possible operating mode, said phase D″) comprises afurther sub-phase, which entails the immersion of said medicalinstrument 60 in a bath of organic solvents.

According to one possible operating mode, said phase A″) comprises afurther sub-phase of dissolving said any remain of tendon 90.

According to one possible operating mode, said phase A″) comprises afurther sub-phase of introducing said medical instrument 60 in anautoclave or other sterilization system.

According to one possible operating mode, said phase A″) comprises afurther sub-phase of introducing said medical instrument 60 in an ovenat a temperature between 25° C. and 150° C.

According to one possible operating mode, said phase A″) comprises asub-phase of immerging of said medical instrument 60 in a chemicalorganic solvent bath.

According to one possible operating mode, said phase B″) comprises thefollowing sub-phases, preferably, but not necessarily, in the followingorder:

-   -   lock said jointed device 70 in a reference position and/or lock        said plunger 96 in its locked position;    -   connect said second endpoint 92 to said jointed device 70;    -   thread said further tendon 90, 190 inside said shaft 65,    -   connect said first tendon endpoint 91 to said frame 57.

According to one possible operating mode, one method comprises thefollowing further phase:

-   -   E″) after the phase B″), calibrate of said medical instrument        60, 160, 260 identifying a new zero position for the plungers.

A fabrication method of the jointed device 70, 170, 270 is describedbelow.

According to one aspect of the invention, one fabrication method of ajointed device 70, 170, 270 comprises at least the following phases, inthe preferred order indicated below:

-   -   (A″) provide a machining fixture 112 on an EDM machine and        arrange a plurality of workpieces 117 on said machining fixture        112.    -   (B″) cut the desired geometry on said workpieces 117 with        cutting lines parallel to each other.

The provision of a single cutting step on said workpieces with cuttinglines parallel to each other, allows the machining of surfaces that areparallel to each other on said workpieces, with an extreme precision ofparallelism.

According to one possible operating mode, the machining method describedabove allows the machining of ruled surfaces characterized by parallelgeneratices on said workpieces 117.

According to one possible operating mode, one machining method asdescribed above allows the cutting of workpieces of very smalldimension, for example of millimetric or sub-millimetric dimensions.

According to an embodiment, said machining method is suitable tofabricate at least one jointed device 70 that comprises a plurality ofjoint members 71, 72, 73, 74, 75, 76, 77, 78.

According to one possible operating mode, said machining method issuitable to machine parallel cuts on said workpieces 117 such as to formjoint members comprising surfaces parallel to each other.

According to one possible operating mode, said machining method issuitable for machining parallel cuts on said workpieces 117 such as toform joint members suitable to be assembled in a complementary fashionbecause they comprise surfaces that are parallel to each other.

According to one possible operating mode, said EDM machine is suitableto perform wire EDM and comprises a cutting wire 115.

According to an embodiment, said cutting wire 115, or EDM wire 115, orelectrical discharge machine wire 115 is of a diameter between 30microns and 100 microns, and is preferably of 50 microns.

The provision of a machining method as described above allowsexclusively thermal energy to be transferred to the piece being machined117, avoiding any mechanical energy to be transferred to the piece beingmachined 117, for example inducing flexion, as it is the case whencarrying out cuts with a milling machine.

According to an embodiment, said machining method is suitable tofabricate at least one jointed device for applications in themedical-surgical sector.

According to an embodiment, said machining method is suitable tofabricate at least one jointed device, suitable for applications inprecision mechanics, for example suitable for use in watchmaking.According to an embodiment, said machining method is suitable tofabricate at least one jointed device, suitable for applications in thejewelry and/or fashion jewelry sector. According to an embodiment, saidmachining method is suitable for the fabrication of at least one jointeddevice, suitable for applications in the assembly of electromechanicalproducts.

According to one possible operating mode, the phase (A′″) comprises thefollowing sub-phases:

-   -   mount a plurality of workpieces on said machining fixture 112 in        their respective member seats 116.

According to one possible operating mode, a sub-phase is first carriedout during said phase (A′″):

-   -   (A1′″) provide a machining fixture 112 on an EDM machine;        and then the sub-phase:    -   (A2′″) arrange a plurality of workpieces 117 on said machining        fixture 112.

According to a possible operating mode, one method comprises thefollowing further phase between the sub-phase (A1′″) and the sub-phase(A2′″):

-   -   (C′″) carry out a calibration.

According to one possible operating mode, one method comprises thefollowing further phase between the phase (A′″) and the phase (B′″):

-   -   (C′″) carry out a calibration.

According to one possible operating mode, one method comprises thefollowing further phases after the phase (B′″).

-   -   (D′″) rotate said machining fixture 112.    -   repeat said phase (B′″).

According to one possible operating mode, said phase of rotating saidmachining fixture 112 comprises a further phase of using a rotary tableto rotate said machining fixture 112, avoiding to dismount saidmachining fixture 112 from the cutting machine to carry out thefollowing phases:

-   -   rotate said machining fixture 112;    -   carry out a second calibration, or cut calibration, exclusively        on said reference rod 118,    -   repeat said phase (B′″).

According to one possible operating mode, said phase (C′″), carry out acalibration, comprises the following sub-phases:

-   -   switch on the EDM machine;    -   provide a reference rod 118 with its axis parallel to said        member seats 116 of the workpieces 117;    -   bring said cutting wire 115 in contact with a first portion 122        of said reference rod 118, or portion facing towards the side of        wire approach 122;    -   measure, or register, the position of said wire;    -   and/or    -   measure, or register, the position of said cutting wire 115,        when it is in contact with a first portion of a first workpiece        to be machined, or the portion facing the side of wire approach;        execute the previous phase for each workpiece 117;    -   and/or    -   bring the cutting wire 115 in contact with a second rod portion        123 of said reference rod 118, or portion facing the side of        wire departure 123, opposite with respect to said first rod        portion 122;    -   measure, or register, the position of said cutting wire 115;    -   compute the position of the axis of said reference rod 118 as a        midpoint between the position of said wire when in contact with        said first rod portion and the position of said wire when in        contact with said second rod portion.    -   and/or    -   measure, or register, the position of said cutting wire 115 when        in contact with a second portion of said first workpiece, or the        portion facing the side of wire departure;    -   compute the position of said first workpiece as a midpoint        between the position of said wire when in contact with said        first portion of the workpiece and the position of said wire        when in contact with said second portion of the workpiece;    -   and/or    -   execute the previous phase for each workpiece 117;    -   and/or    -   repeat the procedure for all cutting planes X-Y, Y-Z, X-Z.

According to an embodiment, said machining fixture 112 of a jointeddevice 70, 170, 270 is suitable to be mounted on a machine for EDM.

According to an embodiment, said machining fixture 112 is suitable toperform at least two cuts on different cutting planes on workpieces 117by using a single cutting profile 110 per cutting plane.

According to one realization, said machining fixture 112 comprises afirst pair of fixing surfaces 113, 114, which are rectified, oppositeand substantially parallel to each other and substantially orthogonal toa first plane of cutting X-Y.

According to an embodiment, said machining fixture 112 comprises asecond pair of fixing surfaces 134, 135, which are rectified, oppositeand substantially parallel to each other and substantially orthogonal toa second plane of cutting Y-Z.

According to an embodiment, said first pair of fixing surfaces 113, 114and said second pair of fixing surfaces 134, 135 are rectified.

According to an embodiment, each pair of locating surfaces comprises atleast one base fixing surface 113, 135 and at least one fixture fixingsurface 114, 134.

According to an embodiment, said plurality of member seat 116 aresequentially arranged such that a translating straight line,substantially orthogonal to said first cutting plane X-Y, orsubstantially orthogonal to said second cutting plane Y-Z, wouldintersect at most only one of said workpieces 117 at a time, when saidworkpieces are mounted in respective member seats 116.

According to an embodiment, said member seats 116 are substantiallyparallel to each other.

According to an embodiment, said machining fixture 112 also comprises apair of locating surfaces, opposite and substantially parallel to eachother and substantially orthogonal to a third cutting plane X-Z.

According to an embodiment, said third pair of locating surfacescomprises at least a guide hole 125, and the EDM wire 115 of said EDMmachine is inserted in at least one said guide hole 125, to avoid theEDM wire coming into contact with at least one machining fixture 112,during the cut.

According to an embodiment, said machining fixture 112 also comprises:

a plurality of member seats 116, each suitable to receive at least oneworkpiece 117, said workpiece 117 being suitable to realize at least oneportion of said jointed device 70, 170, 270.

According to an embodiment, said machining fixture 112 also comprises atleast one reference rod 118, suitable to allow for the cut calibration.

According to an embodiment, said machining fixture 112 comprises atleast one fixing element, or fastening element, suitable to firmlyconnect said at least one workpiece 117 in its respective member seat116.

According to an embodiment, said at least one fastening element isconductive glue.

According to an embodiment, said at least one fastening element is agrub screw.

According to an embodiment, said grub screw is suitable to be mounted ina threaded hole supplied in said at least one fastening surface.

According to an embodiment, said fastening grub screw, is suitable topenetrate in said threaded hole of said fastening surface.

According to an embodiment, said machining fixture 112 comprises fourmember seats 116 and a reference rod 118.

According to an embodiment, each member seat 116 is substantiallypositioned at the same distance from its respective fastening surface.

According to an embodiment, said fastening surfaces are positioned in astepwise manner, such as to form a stair shape in profile. In otherwords, said fastening surfaces are positioned in a stepwise manner, suchas to form a stair shape in profile with respect to at least one cuttingplane X-Y, Y-Z, X-Z.

According to an embodiment, said machining fixture 112 has a surfacefacing towards any cutting plane X-Y, Y-Z, X-Z inferior to 10000 squaremillimeters.

According to an embodiment, said machining fixture 112 has a surfacefacing towards any cutting plane X-Y, Y-Z, X-Z inferior to 5000 squaremillimeters.

Known microsurgical procedures are carried out manually by the surgeon200, or micro-surgeon 200, by the use of manual instruments, such asforceps, scissors and needle holders used to manipulate very fragiletissues and ducts with a diameter of 1 mm or less. The microsurgicalprocedure step most commonly performed is anastomosis, in which twosmall, severed vessels are sutured back together to reestablish bloodflow. This procedure is carried out by holding the two adjacent vesselstubs with specific clamps and by using small caliber needles to performthe suture. The micro-surgeon 200 must hence perform very smallmovements, trying to limit the natural tremor of the hand and tomaintain a high level of both concentration and sensitivity in order todelicately manipulate the fragile tissues with which he/she interactsvia the instruments. It is apparent that robotics can bring significantimprovement to the performance of complex microsurgical procedures.

According to an embodiment, said robotic assembly 100 has the functionof supporting the surgeon 200 in the execution of a microsurgicalprocedure by using jointed devices and robotic devices that guaranteeextremely precise movements, that scale down the actual hand movement ofthe surgeon 200 eliminating any tremor while reproducing the kinematicsof the human wrist on a small scale.

According to an embodiment, said surgical robotic assembly 100 comprisesa support 104, an articulated macro-positioning arm 30, and a pair ofmicro-positioning devices 41, 141, 241. A medical instrument 60, 160,260, which comprises a motor box 61 and a sterile jointed device 70,170, 270 is attached to each micro-positioning device 41, 141, 241.

Two control devices 20, suitable for the robotic control of the twomedical instruments 60, 160, 260 and of the micro-positioning devices41, 141, 241, are connected to the support 104 by communication cables109. All the electronic control circuit boards and the power sources ofthe robotic assembly 100 are integrated in the support 104, while acontrol panel 108, for switching on and off and the management of usermessages from the robotic assembly 100 by an operator, is situated onits surface. A dedicated, external video-microscope entry allows theintegration of any traditional external microscope 103 for microsurgery.A digital microscope 103 is integrated in the system to visualize thesubstantially overlapping work volume 7 of the two sterile jointeddevices 70, 170, 270.

According to an embodiment, a possible configuration of the surgicalrobotic assembly 100 is specifically dedicated to performingmicrosurgical procedures at the limb extremities or on free flaps. Thisis composed of an operating table 102 on which the limb to be operatedon, or the free flap, is placed and comprises the use of a pair ofjointed devices 70, 170, 270 connected to micro-positioning devices 41,141, 241 and remotely controlled in real time by the microsurgeon 200 bytheir respective control devices 20. Note that microscope 103 is notpart of the surgical robotic assembly 100 but is an independent element,fundamental for the visualization of the work volume 7 during theperformance of the procedure.

According to an embodiment, a possible configuration of the surgicalrobotic assembly 100, particularly suitable for breast reconstructionprocedures, but also suitable for carrying out microsurgeries on allother body parts, is composed of: a support 104 which allows for thesupport of the surgical robotic assembly 100 and for its transfer intothe operating room to a position adjacent to the mobile operating table102 on which the patient 201 is lying, one passive, articulatedmacro-positioning arm 30 that extends from the support 104 and allowsthe active part of the surgical robotic assembly 100 to reach theanatomical site involved in the procedure. A pair of precisionmicro-positioning devices 41, 141, 241, or micro-positioning devices 41,141, 241, each with four degrees of freedom, to which the respectivemedical instruments 60, 160, 260 are attached, and which are used by thesurgeon 200 to perform the microsurgical procedure by handling both thetissue and the small suture needles, are placed at the end of thesurgical robotic assembly 100. The whole procedure is carried out undervision guidance provided by an external, traditional surgical microscope103.

According to an embodiment, the support 104 has both a structural andtransport function for the surgical robotic assembly 100, while themacro-positioning arm 30 connected to it allows the simultaneouspositioning of a pair of micro-positioning devices 41, 141, 241 and themedical instruments 60, 160, 260 in proximity to the anatomical districtwhich will be operated on. The micro-positioning devices 41, 141, 241and the medical instruments 60, 160, 260 are actively moved andcontrolled in real time by the control devices 20.

According to an embodiment, each control device 20 is equipped with asupport clamp or bracket, which can be independently positioned, forexample by connecting it to the operating table 102. Said controldevices 20 are connected to the surgical robotic assembly 100 by a powercable 107, also suitable for the transmission of control data.

According to an embodiment, to simplify the transport of the surgicalrobotic assembly 100, a retractable handle 106 and a foot platform 105are positioned on a posterior side. The cart 104 has a control panel 108on a posterior surface for the management of the parameters of thesurgical robotic assembly 100 by the user and for the display ofmessages or warnings of the machine itself. On/Off switches (powerbuttons) and an emergency stop button are present on the same side. Apower cable 107 supplies electrical current to the entire system, whilethe video data acquired by the digital microscope are passed to thesurgical robotic assembly 100 via a communication cable 109, such as tobe able to integrate vision-derived information into the controls.According to an embodiment, said surgical robotic assembly 100 comprisesa foot platform 105, suitable to be used together or alternatively to aretractable handle 106 for the transport of the robotic assembly 100during its positioning in the operating room, placed on the bottom ofthe posterior side of the cart.

Said foot platform 105 allows the foot of an operator responsible forthe movement of said robotic assembly 100 to rest on it, such that therobotic assembly 100 can also be pushed from the base, eliminating therisk of its tipping over while it is moved.

According to an embodiment, the control device 20 has the function ofcontrolling the robotic movement of the micro-positioning devices and ofthe medical instrument 60, 160, 260. The control device 20 comprises acontrol instrument 21, whose position in space is detected in real timeby a magnetic tracking sensor. The magnetic tracking sensor is made of amagnetic field generator and of wired markers containing micro-bobbins,such as for example, but not limited to, the product “NDI AURORA V3tracking system” comprising a “Planar field generator” and sensor “Mini6DOF” by the company “NDI—Northern Digital Inc., 103 Randall DriveWaterloo, Ontario, Canada N2V1C5”. The control instrument 21 integratesall the markers necessary for the detection of the six spatialcoordinates of the control instrument 21 with respect to a basestructure 67 and comprises an additional degree of freedom of grippinglocated in its tip portion 68, whose angle of aperture is measured by atip sensor 29. Said tip sensor 29 is a position sensor or a proximitysensor. A connection tendon 23 connects the control instrument 21 to abase structure 67 that contains a magnetic field generator, suitableboth for powering and data transmission between the control instrument21 and said base structure 67, particularly, but not necessarily when itcomprises a detection device 22. A power and communication tendon 24connects the magnetic field generator to the external power source atthe cart 104 of the robotic assembly, transferring the data relative tothe position and orientation of the control instrument as well as theaperture angle of the forceps of the control instrument 21. A furthermarker for the detection of the six spatial coordinates of the cart withrespect to the base structure 67 is present on the support 104 andconnected by the power and communication tendon 24 to the base structure67. Status signal lights 26 are integrated in the base structure 67 andcommunicate the activity of the control device to the user. A soft,dedicated, ergonomic operator support 27 is made to allow an ergonomicuse of the control device 20, while the control instrument 21 reproducesthe geometry of traditional micro-instruments such as the forceps andneedle holder to make their handling more intuitive and familiar to thesurgeon.

According to an embodiment, the macro-positioning arm 30 allows theanatomical districts involved in the surgical procedure to be reached bythe active parts of the robotic assembly 100, such as, for example, themicro-positioning devices 41, 141, 241 and the medical instruments 60,160, 260. Said macro-positioning arm 30 is composed of four members 31,32, 33, 34 connected to each other in series by passive rotationaljoints each having vertical and parallel arm movement axes a-a, b-b,c-c. Inside each rotational joint, electromagnetic brakes allow theposition of each single member to be locked in space. A dedicated brakerelease button 35, positioned below on the bottom side of the fourth armmember 34 to facilitate its grasping and activation, allows all jointbrakes to be simultaneously released and thus to reposition each armmember in space as required by the user. The new position can then befrozen by undepressing the release button 35.

According to an embodiment, the first member 31 of the macro-positioningarm 30 is connected to a cart 104 by a rack and pinion mechanism thatallows to manually control the movement of said macro-positioning arm 30within a dedicated linear sliding guide 36 along a preferably verticallinear displacement axis, when a manual knob 37 is turned.

According to an embodiment, the fourth member 34 of themacro-positioning arm 30 has a rotational joint at its tip, which ismanually activated by a dedicated rotational dial nut 43 that turnsaround a fourth axis of arm movement d-d, perpendicular to the thirdaxis of arm movement c-c.

According to an embodiment, the macro-positioning arm 30 is connected tothe support member 38 via the rotational joint, which is manuallyactivated via the movement of said rotational dial nut 43. A pair ofmicro-positioning devices 41, 141, 241 is connected to the twoextremities of said support member 38 that also carries a video camera45 in its middle section, which can display enlarged images of the workvolume 7 in which the microsurgery is carried out. The medicalinstruments 60, 160, 260 are rigidly attached to a distal portion of themicro-positioning devices 41, 141, 241.

According to an embodiment, the micro-positioning device 41, 141, 241comprises three motorized slides 51, 52, 53, orthogonally connected toeach other and able to each move independently along respective threeaxes of linear displacement f-f, g-g, h-h, and a motorized rotary joint46.

According to an embodiment, said motorized slides 51, 52, 53 aremotorized micro-slides. The medical instrument 60, 160, 260 is rigidlyattached to the micro-positioning device 41, 141, 241 by a motorizedrotary joint 46 that turns it around its longitudinal rotation axis r-r.

According to an embodiment, the medical instrument 60 has a motor box 61that contains at least one tendon drive system 50 equipped to drive thejointed device 70 of said medical instrument 60 and its terminal device77. According to an embodiment, the transmission mechanism integratedinside the mechanical transmission box 62, connected to the motor box61, transmits the motion to the medical instrument 60 via the shaft 65to the jointed device 70 and to the terminal device 77.

According to an embodiment, the medical instrument 60 is made of a motorbox 61 containing the actuators for driving the medical instrument 60,the associated electronic control boards and motor driver boards. Themechanical transmission box 62, which contains the mechanisms dedicatedto transmit the motor motion via said shaft 65 along the longitudinalshaft direction X-X, to the jointed device and the terminal device 77,is connected to said motor box 61.

According to an embodiment, the motor box 61 contains six pushingelements 95 associated to three degrees of freedom of the medicalinstrument 60. In particular, said pushing elements are moved by atleast one pusher assembly 94, which comprises electric micro-motors witha linear transmission system lead screws. Actuation pistons 95 come outof the wall of motor box 61 facing the transmission box 62 and actuatethe transmission mechanism integrated into the mechanical transmissionbox 62.

According to an embodiment, the motor box 61 and the mechanicaltransmission box 62 are separated by a sterile barrier 87 and can beintegrally connected with each other by connecting features, for examplevia a bayonet connection, as shown in FIG. 12.

According to an embodiment, the shaft 65 is hollow, fabricated in metal,extends itself along the longitudinal shaft direction X-X and insertsitself into the mechanical transmission box 62. The jointed device 70,170, 270 with the terminal device 77 at the tip is inserted at the othershaft end or tip.

According to an embodiment, the six pushing elements 95, implemented asactuation pistons connected to motors, couple with the respectiveplungers 96 of the mechanical transmission box 62 thus connecting themotor box 61 with the mechanical transmission box 62,

According to an embodiment, said pushing element 95 and said plungers 96are separated by a sterile barrier 87.

According to an embodiment, the plungers 96 can move linearly along thepiston movement axis and are maintained in a proper alignment by meansof linear bushings not represented inserted in the first frame section58, or upper frame 58, and by means of respective shoulder surfaces 88.

According to an embodiment, the actuation of the jointed device 70 isassigned to six tendons 90, or actuation cables 90, which areindependent and run from a tendon fastening surface 84 in the mechanicaltransmission box 62, to the jointed device 70 of the medical instrument60, via the mechanical transmission box 62, the tendon passage hole andthe hollow shaft 65.

According to an embodiment, in its section running inside of themechanical transmission box 62, each tendon 90 winds around eachrespective four guiding pulleys 97, mounted on said lower frame 59, suchas to change its path direction until aligning with the instrument axisX-X. Such guiding pulleys 97 can be a fixed or idle pulleys and in apreferred configuration, they are idle pulleys, with the exceptions ofthe first guiding pulley 197, positioned closest to the first tendonendpoint 91, which is a fixed guiding pulley 197.

According to an embodiment, a further plunger idle pulley 98 ispositioned on each plunger 96 and moves integral with it along thelinear piston pulley movement axis. Each actuation tendon 90 alsopartially winds around the respective plunger idle pulley 98, fastenedto the respective plunger 96. Said plunger idle pulley 98 is locatedbetween said first guiding pulley 197 and a second guiding pulley 297.

According to an embodiment, the movement of the plunger 96 and hence ofthe plunger idle pulley 98 induced by the actuation piston 95, pushesthe tendon 90 and hence varies its path length between said firstguiding pulley 197 and said second guiding pulley 297. This change inlength is transmitted by means of said transmission mechanism to thedistal articulation of the medical instrument 60, 160, 260, resulting inits actuation.

According to an embodiment, a spring 99, suitable to work bycompression, is inserted between the plunger idle pulley 98 and theupper frame 58 around the plunger 96.

According to an embodiment, said spring 99 generates a force directedalong the plunger movement direction axis and establishes a variablepreload on each plunger 96 sufficient to always keep the tendon 90 undera light tension and avoid its derailing from said guiding elements 97,98, 197, 297 during changes in its tensile load.

According to an embodiment, a tendon guide element 89 maintains eachtendon 90 in position and impedes its derailing, even in cases ofanomalies such as a loss of tension in the tendons 90.

According to an embodiment, the jointed device 70 uses six low-friction,low minimum curvature radius and high stiffness polymeric tendons asmovement transmission means for actuation of the three degrees offreedom of motion that the jointed device 70, 170, 270 is capable of.Each actuation cable, or tendon, 90, is glued with a low viscosityacrylic glue to tendon fastening surface 84 of the lower frame 59 andchanges its direction by passing across four successive guide elements97, 197, 297, integral to the lower frame 59 until it reaches the centerof the transmission box 62 and enters through a central hole in theshaft 65 of the medical instrument 60, 160, 260 running in the directionof the instrument X-X, down to the jointed device 70, 170, 270.

As shown in FIG. 13, the first guiding pulley 197 of each actuationcables 90 is a fixed pulley 197 on which the tendon 90 winds. Successiveguide elements are idle pulleys, around which tendon 90 is partly wound.Between said first guiding pulley 197 and said second guiding pulley 297a space is provided allowing the linear motion of the plunger 96actuated by the actuation piston 95.

According to an embodiment, at least one tendon 90 winds around at leastfour guiding pulleys 197, 297, 397, 497, thus defining a third guideelement 397 and a fourth guide element 497. Between said third guideelement 397 and said fourth guide element 497, a tendon guide element 89keeps the tendon 90 in the correct position and avoids derailing of thetendon 90, even in cases such as an anomalous loss of tension.

According to an embodiment, the joint members that form the jointeddevice 70, 170, 270 and its terminal device 77, reproduce the kinematicsof the human wrist adding a grasping degree of freedom of movement atthe tip, for a total of three degrees of freedom of movement.

According to an embodiment, a first joint member 71 and a second jointmember 72 are connected to each other by a rotational joint 171 around afirst axis of rotation P-P, followed by a first portion of the terminalmember 177 and a second portion of the terminal member 277, bothconnected to said second joint member 72, which freely rotate around asecond axis of joint movement Y-Y, orthogonal to the first axis of jointmovement P-P and providing a terminal device 77 at the tip.

According to an embodiment, the first member 71 locks on or is jointedin a concentric manner with the shaft 65 of the medical instrument 60and is rigidly attached to it via fastening pins 76.

According to an embodiment, six actuation cables 90 run through themedical instrument shaft arranged respectively two planar groups ofthree symmetrically arranged with respect to a shaft section planedefined by the axis of the instrument X-X and by its first joint axis ofjoint P-P.

According to an embodiment, the tendon and opposite tendon 90,190associated to second joint member 72, providing for its clockwise andanticlockwise rotation around said first joint axis of movement P-P, arearranged opposite to each other with respect to said section plane,slide over two opposite lateral sliding surfaces 40 of the first member71, then both cross said section plane before said first axis of jointmovement P-P, then they wind around at least one joint sliding surface80 of the second member 72 and finally they attach to said second member72.

According to an embodiment, the tendon and opposite tendon 90 associatedto the first portion of the terminal member 177, like the two tendons 90associated to the second portion of the terminal member 277, both run onthe same side of said shaft section plane, they both slide on the samelateral sliding surface 40, 140 of first member 71, then they both crosssaid section plane before the first axis of joint movement P-P, thenthey both wind around at least one same sliding surface 80 of the secondmember 72 and continue their path to end up winding in oppositedirections on the winding surface 86 of the terminal member 77. Whenonly the first portions of the terminal member 177 or only the secondportion of the terminal member 277 are actuated, the tendons 90associated to said first portion of terminal member 177 and associatedto said second portion of terminal member 277 slide along the slidingsurface 80 of the second member 72.

According to an embodiment, the movement of the jointed device 70 isrealized by polymeric actuation cables 90, or polymeric tendons 90.These tendons 90 run through the mechanical transmission box 62, runalong the whole hollow shaft 65 and arrive at jointed device 70 andterminal device 77.

According to an embodiment, the transmission of motion to the joints ofthe jointed device 70 is a function of the path of the tendons 90 in thejointed device.

Exploiting the low friction, the very small curvature radius of thetendons 90, the tendons slide across the joint members that make up thejointed device and they wind around the various joint axes of movementP-P, Y-Y.

According to an embodiment, the members that make up the jointed device70 are in fact rotationally connected to each other by an axis supportfeature of the rotational joint 171. Each member has joint slidingsurfaces 80, or joint winding surfaces 86 for the tendons 90, botharound the joint axis of movement P-P, Y-Y and along its body.

According to an embodiment, a further elbow joint member 75, positionedbefore a wrist joint member 78, suitable to reproduce the kinematics ofthe human wrist, can be included by provisioning an elbow joint member75 characterized by having two distinct parallel axes of joint movementP-P, P-P. According to an embodiment, the first member 71 is coupled tosaid elbow member 75 having two distinct and parallel axes of jointmovement P-P, P-P, one more proximal and one more distal, that are thefirst joint and second joint respectively. Said elbow member 75 has twolateral sliding surfaces 40, 140 arranged laterally opposite to eachother with respect to a second section plane, defined as the plane thatcontains the first axis P-P and the second joint movement axis Y-Y.

According to an embodiment, there are eight actuation cables 90, 190.Said eight actuation cables, or tendons, run on the lateral slidingsurfaces 40, 140 of the first member, arranged in one group of fouropposite to another group of four with respect to said first sectionplane, and they cross said section plane before the first axis of jointmovement P-P, hence they run on the first joint sliding surface 80 ofthe elbow member 75.

According to an embodiment, two actuation cables 90, 190, dedicated tothe motion of rotational joint 171 of the elbow member, are terminatedon said elbow member 75. The remaining six cables 90, 190 continue alongthe lateral sliding surfaces 40, 140 of the rotational joint 171 of theelbow, crossing a second section plane before said second joint axis.The following progression of the tendons around the second, third andfourth members 72, 73, 74, to the first portion of terminal member 177and the second portion of terminal member 277 is analogous to what hasbeen previously described in the presentation of the wristconfiguration.

According to an embodiment, all members that form the jointed device 70and the terminal device 77 are fabricated by a wire EDM performed on twoorthogonal work planes X-Y, Y-Z.

According to an embodiment, fabricating the first member 71 startingfrom a cylindrical piece to be machined 117, said first member presentstwo circular surfaces that allow its concentric insertion into the shaft65.

According to an embodiment, said circular surfaces present matingfeatures on a lower portion, such as through-holes, that permit therigid attachment of said first member of shaft 65 by means of fasteningpins 76. Said first member 71 presents on a distal portion two featuresto support rotational joint 171, each characterized by a cylindricalseat centered around said first axis of joint movement P-P and a lateralshoulder surface.

According to an embodiment, all holes, being machined by wire EDM suchas the pin holes 79, have extra machining grooves 49 resulting from thepassage of the cutting wire 115.

According to an embodiment, having defined said first section planecontaining the axis of the instrument X-X and the first joint movementaxis P-P, the first member 71 presents two opposite tendon slidingsurfaces 40, 140 each having rounded shapes that are symmetricallyopposite i.e. mirrored with respect to said section plane.

According to an embodiment, being machined by wire EDM, each slidingsurface 80, 180, 40, 140 is resulting from the sweeping motion ofparallel straight generatrices that move directly along a cuttingprofile 110.

According to an embodiment, the actuation cables 90 slide in two groupsof three, respectively along the two lateral sliding surfaces 40, 140,one opposite to the other on the first member 71 and they cross saidsection plane before the first axis of rotation to then continue ontosecond member 72.

According to an embodiment, said second member 72 has a joint slidingsurface 80 proximally, arranged around said first axis of joint movementP-P having a cylindrical portion.

According to an embodiment, said joint sliding surface 80 is formed byparallel straight generatrices following the wire EDM cutting profile.

According to an embodiment, a pin holding feature 76 and a lateralshoulder surface characterize the joint of the first member 71 aroundthe first axis of joint movement P-P. Two tendon termination features 82are laterally derived from the second member 72 allowing the fasteningof second tendon endpoint 92 of the second member by knot or gluing.Distally, two support features for the third and fourth rotational jointare each characterized by a pinhole 79 around the second axis of jointmovement Y-Y and a lateral shoulder surface.

According to an embodiment, the second axis of joint movement Y-Y isorthogonal to the first axis of joint movement P-P. Being machined bywire EDM, the pinhole 79 has machining grooves 49, resulting from thecutting wire 115.

According to an embodiment, the third member 73 is characterized by apinhole 79 located around the second axis of joint movement Y-Y. Thethird member 73 is mated to the second member 72 by a seat for a jointpin and an associated lateral shoulder surface. A winding surface 86 ofthe actuation cables 90, 190 allows the winding of the actuation cables90, 190 around that winding surface 86 that is concentric to the secondaxis of joint movement Y-Y.

Laterally to the third member 73 a tendon termination feature 82 andtendon fastening points 82 are derived. The tendon termination feature82 allows the passage of the tendons 90, and the tendon fastening point82 holds the second tendon endpoint 92, 192 of the third member 73,defined by knots.

According to an embodiment, the first portion of the terminal member 177and the second portion of the terminal member 277 are jointed to thesecond member 72, sharing the same second axis of joint movement Y-Y.

According to an embodiment, the first portion of the terminal member 177mirrors the shape of the second portion of the terminal member 277.

According to an embodiment, the third member 73 can be individuallymated to the second member 72 if the terminal device 77, present on thethird member 73, is a medical instrument 60 of a surgical ormicrosurgical type, similar to, for example to a scalpel blade.

According to an embodiment, a terminal member 77, can be individuallyjointed to said second member 72, only if the terminal device 77 isitself a medical instrument 60 of a surgical or microsurgical typesimilar for example to a scalpel blade or to a fiber-optic tendoncarrier for laser light treatments. In this case, the jointed device 70will only comprise two degrees of freedom of movement, in particular ofpitch and yaw, losing the degree of freedom for grasping.

According to an embodiment, the first portion of terminal member 177 andthe second portion of terminal member 277 can mate with each definingdifferent terminal devices 77, such as a micro device for cutting, aterminal micro device providing a straight grasp, a micro deviceproviding angled grasping, a needle holder and other traditionalmicrosurgical instruments as illustrated in FIGS. 25-27. The terminaldevices reproduce the form, proportions and functionalities oftraditional microsurgical instruments tips, in order to facilitate theirrecognition and use by the microsurgeon 200.

According to an embodiment, fastening pins 76 are inserted in the pinholes 79 of the members of the jointed device 70. The fastening pins 76are preferentially made of hard metal, rectified and polished to reducesliding friction.

According to an embodiment, the fastening pins 76 have interference inmating with the pin holes 79 located in correspondence to the axes ofjoint movement P-P, Y-Y, of rotational joint 171.

According to an embodiment, the fastening pins 76 have leeway, orclearance, in the pin holes 79 associated to the winding surfaces 86.

According to an embodiment, the connection by fastening pins 76 betweenthe first member 71 and the second member 72 forms a rotational joint,suitable to rotate around the second axis of joint movement P-P, with anassociated actuation angle substantially comprised between +90° and−90°.

According to an embodiment, the connection by a single fastening pinbetween the second joint member 72, the first portion of terminal member177 and the second portion of terminal member 277 creates a rotationaljoint between said three members 72, 177, 277 with an associatedactuation angular range substantially between +90° and −90°. Said jointdefines two degrees of freedom, characterizing both the yaw and thegrasp of the medical instrument 60.

According to an embodiment, the polymeric tendons 90, 190 can beterminated in several ways, provided that, as a result of strongfastening, they can be tensioned and such a tension is also transmittedto the joint member, or to the part to which they are connected, drivingits motion.

According to an embodiment, the tendons 90 run through a tendontermination feature 82 and are locked by a knot formed by the tendon 90itself, located at said tendon fastening point 82.

According to an embodiment, a second method for fastening the tendon 90,used for example for the actuation of the second member 72, provisionsthe passage of a loop of the tendon 90 around a tendon fastening point82 and the application of tension to both the extremities of the tendon90, such that the two sides of the tendon 90 act as a single tendon 90,halving the loads to which it is subject.

According to an embodiment, a third fastening method of the tendons 90provisions the insertion of tendon portions in tendon fastening points82, intended for this use, and the use of glues specific for the polymerof which the tendons 90 are made, such as those used for example forgluing the first endpoint 91 to the lower frame 59 of the mechanicaltransmission box 62 of the tendon drive system 50.

According to an embodiment, the jointed device 70 is characterized bythree degrees of freedom of movement, and in particular by one degree offreedom of pitch between the first member 71 and the second member 72,one degree of freedom of yaw between the second member 72 and the thirdmember 73, one degree of freedom of gripping, or grasping, between thefirst portion of terminal member 177 and the second portion of terminalmember 277.

According to an embodiment, the second joint member 72, the firstportion of the terminal member 177 and the second portion of theterminal member 277 can move around respectively said first axis ofjoint movement P-P and said second axis of joint movement Y-Yindependently. The movement of the medical instrument 60 is carried outby the actuation cables 90, which run over the members jointed to eachother by rotational joints.

According to an embodiment, a pair of tendons 90, 190 comprises a tendon90 and an opposite tendon 190, which is suitable to work as a pair ofagonistic and antagonistic tendons associated to a first portion of theterminal member 177 and a further pair of tendons 90, 190, comprising atendon 90 and an opposite tendon 190, suitable to work as a pair ofagonistic and antagonistic tendons associated to the second portion ofthe terminal member 277, and a further pair of tendons 90, 190,comprising a tendon 90 and an opposite tendon 190, suitable to act as apair of agonistic and antagonistic tendons associated to the secondjoint member 72.

According to an embodiment, a pair of tendons, 90, 190, comprising atendon 90 and an opposite tendon 190, suitable to work a pair ofagonistic and antagonistic tendons, transmit a rotational movement tothe second portion of the terminal member 277, around said second axisof joint movement Y-Y, running over the lateral sliding surface 40 ofthe first joint member 71, crossing said section plane, running on thejoint sliding surface 80 of the second joint member 72, and thensplitting to wind them respectively in opposite directions around thewinding surface 86 of the second portion of terminal member 277 andterminating with a knot. When one of the two tendons 90, 190 istensioned or released, it slides on a sliding surface 40 of the firstjoint member 71 and over sliding surface 80 of the second joint member72, while it winds itself or unwinds over the winding surface 86 of thefourth joint member like over a fixed pulley.

According to an embodiment, a further tendon pair 90, 190 consisting ofa tendon 90 and an opposite tendon 190, actuates the first portion ofterminal member 177 in a similar fashion to the way the second portionof terminal member 277 is actuated.

According to an embodiment, a yet further tendon pair 90, 190,consisting of a tendon 90 and an opposite tendon 190, suitable to workas a pair of agonistic and antagonistic tendons, move second jointmember 72 around first axis of joint movement P-P, running over thelateral sliding surface 40, 140 of the first member 71, on one side withrespect to said section plane of the medical instrument 60, intersectingsaid section plane, winding themselves in the opposite directions on thejoint sliding surface 80 of the second joint member 72, and terminatingat tendon fastening points 82. In particular, each actuation tendon 90,190 of the second joint member 72 is formed in a loop that passes aroundrespective tendon fastening point 82 and comes back doubled up, passingover the winding surface 86, joint sliding surface 80 and lateralsliding surface 40 along a path analogous to that followed by theopposite tendon.

According to an embodiment, when moving the second joint member 72around the first axis of joint movement P-P, in one rotation direction,both the end of the tendons 90, 190 are subject to tension. Furthermore,differently from the two tendon pairs 90, 190 that actuate the firstportion of terminal member 177 and the second portion of terminal member277 respectively, in the case of tendons 90 of the second joint member72, the tendons 90, when moving, do not slide over the sliding surfaceof the second joint member 72, but wrap or unwrap around said jointsliding surface 80, as though it were a pulley.

According to an embodiment, six independent tendons 90 are used for theactuation of the threes degrees of freedom of movement of the jointeddevice 70, but eight cables intersect on said section plane between thelateral sliding surface 40 of the first joint member and the lateralsliding surface 80 of the second joint member 72, because both loop endsof the actuation cables 90, 190 of the second member 72 are tensionedduring the movement in one direction around the first axis of jointmovement P-P.

According to an embodiment, the sliding surfaces 80, 180 between theactuation cables 90 and members of the jointed device 70 are reduced toa minimum surface area, such as to reduce friction. The tendons 90, 190are terminated at their second tendon end points 92 such a way thattheir tendon path T-T remains parallel to the instrument axis X-X asmuch as possible, avoiding transversal forces.

According to an embodiment, the intersection of the tendons 90 and theircrossing of said section plane between the joint sliding surface 40 andthe first axis of rotation P-P prevents the tendon 90 from leaving thejoint sliding surface 80 during its movement and guarantees a constantlength and angle of the tendons 90, 190.

A method for machining tridimensional, assemblable mechanicalmicro-components by EDM is described below. In particular, it regardsthe fabrication of jointed devices 70 of a characteristic outer diameterinferior to 4 mm for application in micro-surgery. Furthermore, the maincharacteristics of a specific machining fixture 112, which is afundamental element for the set-up of a production process in aneconomically sustainable fashion and which is capable of guaranteeingthe required precision, are described below.

According to an embodiment, the need to produce micro-parts with manymechanical details and a high level of precision requires the use ofhard metals as a structural material and requires wire EDM as themachining process for the parts. As is known, EDM is a subtractivefabrication process in which material is removed by a conductive piecewith a series of current discharges between the piece itself and anelectrode kept at an electrical voltage difference, separated by adielectric liquid such as water or oil, until the desired shape isobtained. In particular, during wire EDM machining, the workpiece 117 isheld fixed and is immersed in a bath of dielectric liquid while a metalcutting wire 115, made of copper or brass for example, and of a diametervarying between 0.5 mm and 0.02 mm, continuously runs between twobobbins. The cutting wire 115 is sustained by an upper guide and a lowerguide, which being driven by a computer numeric control system in thehorizontal plane, carry out two-dimensional cutting profiles. Themovement of the guides is very precise, and the overall machiningresolution is close to 1 micron (μm), nevertheless, the planar cutsubstantially limits the fabrication of three-dimensional parts. Despitethe fact that some advanced machines have an upper guide, which can moveindependently in the horizontal plane, the ability to produce complex 3Dparts has not substantially increased.

The primary advantages of wire EDM comprise:

-   -   the possibility of machining hard metals,    -   absence of direct contact between the tool and the piece to be        machined 117    -   delicate details can be machined without distortion,    -   a good superficial finish can be obtained,    -   complex shapes, otherwise difficult to produce with conventional        cutting instruments can be produced, while maintaining very low        tolerances.

The manual phases for the fastening each single, metallic workpiece tobe machined 117 to the machine for each of the cutting planes and thefollowing calibration of the machine itself, are very slow phases duringthe fabrication of the parts and are also the phases which result in thegreatest geometric errors that hinder the perfect mating betweenmicro-parts produced individually.

According to an embodiment, in order to substantially decrease thefabrication time and guarantee the precision required for the correctmating of the fabricated micro-parts, a machining fixture 112 isprovided, which intended specifically for this use. It provides amechanical support, which allows the simultaneous fastening andmachining of all the workpieces 117, simplifying assembly of at least aportion of a jointed device 70 on one or more difference planes, with asingle cutting profile 110 and a single calibration step.

According to one possible operating mode, the frontal plane of themachining fixture 112 has member holes 116, suitable to hold theworkpieces 117 with very tight tolerance, that is to say at least H6h5.

According to one possible operating mode, the frontal plane of themachining fixture 112 has a “stepped” profile to allow threading shortthrough holes on the stepped lateral planes.

According to one possible operating mode, grub screws M2 fasten theworkpieces 117 to the machining fixture 112 and guarantee a perfectelectrical conductivity with said machining fixture 112, whichfundamental for a successful EDM process.

According to one possible operating mode, the grub screws disappearunder the plane to which they are screwed, i.e. are headless, to avoidlimiting securing the fixture along those planes, with a vise of an EDMmachine.

According to one possible operating mode, an alternative to the grubscrews and to the threaded holes associated to the grub screws is theuse of conductive glue, to fasten the workpieces 117 to the machiningfixture 112 and guarantee a perfect electrical conductivity with saidmachining fixture 112.

According to one possible operating mode, the arrangement of theworkpieces 117 on the machining fixture 112 is such that they notoverlap in the work planes, for example in the X-Y and Y-Z planes, suchthat different and independent details or profiles can be cut for eachplane on each workpiece 117, by providing a single and continuouscutting profile 110 for the wire.

According to one possible operating mode, the gap, or non-overlappingsection, between two adjacent workpieces is minimized such as to keepthe dimensions of the machining fixture 112 as compact as possible. Inthis way, it is possible to minimize the distance between the upper andlower guides, improving the machining precision.

According to one possible operating mode, a metallic reference rod 118is inserted in the machining fixture 112 and is used for calibration ofthe EDM machine once the machining fixture 112 and the workpieces 117are mounted on the machine.

According to one possible operating mode, a first calibration isprovisioned, which is carried out only once for a given machiningfixture 112, loaded with all the workpieces 117 and a given EDM machinebeing used for the machining. Said first calibration is capable toidentify and compensate all errors related to the EDM machine and to thegeometric errors of the machining fixture 112, such as for example thoserelated to the relative position between the reference rod 118 and theworkpieces 117.

According to one possible operating mode, once the positions of theworkpieces 117 are defined with respect to the reference rod 118 in thevarious cutting planes, the cutting profiles 110 are generated, takinginto account of any differences of the actual positions with the nominalones.

According to one possible operating mode, said first calibration will berepeated only if the EDM machine is changed or a new machining fixture112 is being used.

According to one possible operating mode, each time the machiningfixture 112, loaded with the workpieces 117, is secured to the vise ofthe EDM machine before a cut, a second calibration procedure isforeseen, or a cut calibration, performed only on the calibration rod118. This cut calibration process eliminates geometric offset and errorsrelated to the manual fastening of the fixture and identifies the originof the machine reference system with respect to the axis of thereference rod.

According to one possible operating mode, to allow the correct fasteningof the machining fixture 112 to the vise of the EDM machine, saidmachining fixture 112 has at least a pair of fastening or fixingsurfaces 113, 114, opposite and parallel to each other, and rectified,meant to be gripped by the jaws of the vise, and a flat posterior X-Zsurface, rectified and orthogonal to the fixing surfaces 113, 114, meantto be flush with an reference surface of the machine, orthogonal to thevise's clamp.

According to one possible operating mode, by not using rotary table inthe EDM machine, it is necessary that the machining fixture 112 have apair of fixing surfaces 113, 114 that are flat, parallel and rectified,opposite to each other for each cut plane provisioned for thefabrication of the micro-components.

According to one possible operating mode, other cutting planes can beproduced by appropriately modifying the machining fixture 112.

According to one possible operating mode, to machine in a thirdorthogonal plane, it is necessary to provision openings 125 in themachining fixture that allow the cutting wire 115 to be inserted on theinside of the machining fixture and hence avoid the cutting of portionsof the machining fixture 112, for example. Several independent cuttingprofiles must be used however without requiring further calibrations.Nevertheless, at the end of every cutting profile 110 in said plane, thecutting wire 115 must be cut and reinserted in the next opening 125.

According to one possible operating mode, the fabrication process usedfor the fabrication of parts of a jointed device 70, provisions theinsertion of four workpieces 117 composed of metallic cylinders made oftool steel, into member holes 116 on the front side of said machiningfixture 112 and then their fastening with grub screws of M2 size.

According to one possible operating mode, all three-dimensionalmicro-part that form the jointed device 70 for micro-medicalapplications, are machined from metallic workpieces 117, in particularsteel cylinders of 3 millimeter outer diameter and 12 millimeter length,that are machined by wire EDM on two planes, X-Y and Y-Z.

According to one possible operating mode, the machining fixture 112loaded with the workpieces 117 is secured on the vise of the EDM machineby using the fixing surfaces 113, 114 as reference planes for thefastening and then the calibration in the X-Y plane is performed usingthe axis of the reference rod 118, rigidly attached to the machiningfixture 112, as a reference. The first cutting profile 110 is performed,machining all the workpieces 117 fastened to the machining fixture 112,in the X-Y plane.

According to one possible operating mode, the machining fixture 112 isthen removed from the machine and remounted, rotated by 90° to machinealong said second plane Y-Z of the machining fixture 112.

According to one possible operating mode, a second calibration for thesecond work plane Y-Z is performed and then the cut of the second cutprofile 210 is carried out.

According to one possible operating mode, by equipping the EDM machinewith a rotating or orientable table, it is possible to perform the cutcalibration process just once and rotate the work plane as necessarybetween one cut profile and the next.

According to one possible operating mode, at the end of the second cutprofile 210 the components produced are completely detached from theworkpiece and can be collected in the EDM machine bath.

Due to the provision of a robotic assembly, according to one aspect ofthe invention, it is possible to control the positioning and motion ofat least one jointed medical instrument within a work volume, in areliable, precise and easily controllable manner.

Due to the provision of a robotic assembly, according to one aspect ofthe invention it is possible to control the positioning and simultaneousmotion of at least two jointed medical instruments, each comprising onejointed device operative within a workspace, in a reliable, precise andeasily controllable manner, potentially reaching every body part of thepatient with the terminal portions of said medical instruments.

Due to the provision of a robotic assembly according to one aspect ofthe invention, comprising an image capturing system, but lacking anintegrated microscope, it is possible to limit the cost as well as thephysical volume of said assembly, resulting in a compact platformcompatible with the installation of a pre-existing microscope, henceallowing retro-fitting operations.

Due to the provision of a robotic assembly according to one aspect ofthe invention, having as few moving parts as possible that require alarge range of movement during the movement of the terminal portion ofthe medical instrument, it is possible to provide a microsurgicalrobotic assembly of low encumbrance, improving the comfort of themicro-surgeon, who can, for example, tele-operate while being in theimmediate vicinity of the operating table and hence can see and directlyaccess the operating field, as well as improving the overall workingconditions of the surgical team, by, for example, avoiding collisionswith mobile parts of the robot while accessing the operating field, aswell as simplifying the transport of the robotic assembly, or the flowof people or air around the robotic assembly. Equally, it becomespossible to use two or more robotic assemblies simultaneously on onepatient.

Due to the provision of a control device according to one aspect of theinvention, it is possible to simplify the teleoperation master interfaceand make it more intuitive and comfortable, without limiting itsfunctionality. At the same time, the training time required by asurgeon, not necessarily specialized in microsurgical procedures, toachieve a sufficient level of mastery of the control device, is reduced.

Due to the provision of a microsurgical robotic assembly, according toone aspect of the invention, comprising a control instrument suitable toreplicate the shape of a traditional surgical or microsurgicalinstrument, it is possible to provide a familiar master interface forteleoperation to the surgeon, without compromising the accuracy of themanipulation.

At the same time, according to one aspect of the invention, due to theprovision of at least one sensor coupled to an electromagnetic 3 Dtracking device, said control instrument is also suitable to replicatethe functionality of traditional surgical or microsurgical instruments,while allowing a complete freedom of movement in the three dimensions ofspace and allowing easy repositioning of the control device, for examplebetween the operating table and the microscope, still guaranteeing goodperformance of the robotic system in terms of response time.

At the same time, according to one aspect of the invention, due to theprovision of a compact control device and at least one sensor, suitablefor relating the robotic assembly and the detection device to a commonreference system, it is possible to freely position said control devicein a simple manner, for example said control device can be positionednext to the operating table, or on a support table close to themicroscope, or in a position deemed ergonomic for the surgeon lookinginto the microscope.

Due to the provision of a control instrument according to one aspect ofthe invention, which replicates the shape of a traditional microsurgicalinstrument having at least one joint at its tip, such as for exampletweezers of forceps, equipped with at least one aperture sensor, it ispossible to control the opening and closing, as well as grip movementsof a jointed medical device in a familiar and precise manner.

The provision of a medical instrument comprising a jointed device movedby tendons according to one aspect of the invention, reduces thecomplexity of its machining, for example by eliminating the provision ofchannels or sheaths, allowing extreme miniaturization of the medicalinstrument, without reducing its reliability during use or assembly.

Due to the provision of a jointed device according to one aspect of theinvention, comprising actuation cables, or tendons, made of non-metallicmaterial, for example polymeric material, it is possible to reduce thecurvature radius of said tendons, as well as the friction coefficient ofsaid tendons and consequently miniaturize further the jointed device.

Due to the provision of a jointed device according to one aspect of theinvention, comprising ruled surfaces with all parallel generatrices forthe sliding of said tendons as well as tendon termination featuresarranged in a specific geometrical relationship to said surfaces, it ispossible to do without tendon guide channels or sheaths, stillguaranteeing parallelism of the tendons and hence allowing an extrememiniaturization of the jointed device.

Due to the provision of a fabrication method according to one aspect ofthe invention, as well as a machining fixture, suitable to guarantee thesimultaneous positioning of several workpieces in a manner that permitsto their cutting lines to remain parallel to each other, it is possibleto obtain a single cut path by a EDM cutting wire for each cuttingplane, on a plurality of workpieces. In this way, it is possible togenerate parallel surface on said pieces, with high tolerances, even incases where very detailed, small shapes are machined.

Due to the provision of a fabrication method according to one aspect ofthe invention, it is possible to produce micromechanical partsguaranteeing a high degree of precision as well as surfaces suitable formedical and/or surgical applications.

Due to the provision of a fabrication method, according to one aspect ofthe invention, it is possible to produce a medical instrument morerapidly with respect to known solutions, and as a consequence, morecost-efficiently.

Due to the provision of a machining fixture, as well as a fabricationmethod, according to one aspect of the invention, it is possible toobtain a fast and efficient process, even for repeated positioning ofthe workpieces within the machine.

Due to the provision of an improved machining fixture for EDM accordingto one aspect of the invention, which accelerates the cutting process ona plurality of cut planes, it is possible to reduce the number andduration of the phases dedicated to calibrating the machine.

Due to the provision of a fabrication method for electro erosionaccording to one aspect of the invention, which permits the machining ofmicromechanical parts comprising cavities and ridges, that, even whenleaving a groove between two prongs 81 of material, are suitable to formpin holding features without having to machine holes, it is possible tosignificantly reduce the machining time.

Due to the provision of a tendon drive system according to one aspect ofthe invention, it is possible to guarantee the movement of said tendonsexclusively by a pusher assembly, suitable to push the tendons andproduce tensile load on at least a portion of said tendon. In this way,the drive system avoids pulling on the tendons, for example by clingingto a portion of the tendon or by wrapping a portion of the tendon arounda winch.

Due to the provision of a tendon drive system according to one aspect ofthe invention, the number and complexity of the components of said driveare reduced and any backlash of the parts when they are not loaded canbe avoided, making the system suitable for extreme miniaturization,without diminishing its reliability or its precision.

The provision of a tendon according to one aspect of the invention,allows the reduction of an outer diameter dimension of said tendon andas a consequence, of the medical instrument, without reducing itsperformance in terms of durability or reliability.

Due to the provision of a tendon according to one aspect of theinvention, it is possible to guarantee improved performance in term ofsliding friction of said tendon on at least a portion of said medicalinstrument, with respect to known solutions.

Due to the provision of a tendon, as well as a tendon replacementmethod, according to one aspect of the invention, it is possible toincrease the working lifespan of said instrument with respect to knownsolutions.

Due to the provision of a tendon according to one aspect of theinvention, produced of non-metallic material, for example polymericmaterial, it is possible to reduce the curvature radius of said tendon,as well as the friction coefficient of said tendon, and consequentlyincrease the miniaturization of the medical instrument that comprisessaid tendon.

Due to the provision of a tendon according to one aspect of theinvention, it is possible to do without the provision of tendon guidecanals or sheaths in the medical instrument, still guaranteeing theparallelism between a plurality of tendons and hence allowing an extrememiniaturization of the medical instrument.

Due to the provision of a tendon 90 comprising a second tendon endpoint92 as described above, it is possible to obtain a jointed device 70 inwhich its members do not require tendon guides or channels to facilitatethe tendon 90 routing, without said tendons 90 interfering with eachother. In fact, the geometric location of said tendon endpoints 92 ischosen in a way that said tendons 90 run substantially parallel to eachother and parallel to said sliding surface 40, 80.

Due to the provision of a sliding surface, for example lateral slidingsurfaces 40 and joint sliding surfaces 80, as previously described, itis possible to for said tendons to slide over the jointed device withlow friction.

Due to the cooperation between said sliding surfaces 40, 80 and thegeometric location of said first tendon endpoints 91 and said secondtendon endpoints 92 it is possible to guarantee that the friction forcesbetween the tendon and the sliding surface, as well as the fasteningreactions at the first and second tendon endpoints 91 and 92 aresubstantially parallel to each other and along a same axis.

Due to cooperation between said sliding surfaces 40, 80 and thegeometric location of said first tendon endpoints 91 and said secondtendon endpoints 92, it is possible to obtain an extreme miniaturizationof said medical instrument 60. For example, in this way it is possibleto do without pulleys and/or other tendon guides, which are not suitableto be miniaturized beyond a certain threshold. For example, according toan embodiment, the shaft 65 of said medical instrument can measure 3millimeter in outer diameter.

Due to the provision of tendons 90 sustaining a curvature radius smallerthan or substantially equal to 1 millimeters, it is possible to design atendon path T-T, that at least partially wraps around said members 71,72, 73, 74, 75, 77, 78, 177, 277 of said jointed device 70, such as toavoid the formation of loops, when for example at last a portion of saidjointed device 70 moves with respect to an axis of movement P-P, Y-Y.

Due to the provision of said tendon drive system 50, as well as a tendon90, 190 having said first tendon endpoint 91 and said second tendonendpoint 92, being a boss, and/or a knot, and/or glued as previouslydescribed, it is possible to mount as well as easily replace a tendon90, 190 with high precision, prolonging the working lifespan of saidmedical instrument 60. Furthermore, due to the provision of tendons madeof polymeric material, the members of said jointed device 70 are notdamaged during working conditions.

Due to the provision of a tendon drive system 50 comprising at least apusher assembly 94 suitable to push, while resting on a tendondeflectable portion 93 of a tendon 90, it is possible to actuate saidtendons without squeezing them or wrapping them around a capstan.

In this way, it is possible to avoid damaging them when in workingconditions, and hence increase the lifespan of said tendons, as well asof said medical instrument 60, diminishing maintenance costs.

Due to the provision of a tendon drive system 50 as previouslydescribed, it is possible to reduce to a minimum the backlash within thetendon drive system 50, always providing a defined preload.

Due to the provision of a substantially linear pusher assembly, it ispossible to integrate micrometric actuation systems, such as slides andpiezoelectric actuators, to control the tensile load of the tendons, aswell as to release and pull exact lengths of tendon, allowing to move atleast a portion of said medical instrument by a desired amount, forexample around a movement axis.

The provision of a tendon drive system suitable for cooperating with ajointed device across a sterile barrier allows the production of amedical instrument, which is highly reliable and sterile.

Due to the provision of a fabrication method based on EDM as previouslydescribed, it is possible to fabricate an entire jointed device withonly one placement step in a machine, decreasing the fabrication timeand cost, without decreasing the reliability or precision of machining.

Due to the provision of a fabrication method according to one aspect ofthe invention, it is possible to produce joint members of a jointeddevice having ruled surfaces with parallel generatrices, such as toallow a tendon sliding over them maintain a stationary path with respectto said joint member. This allows the friction between the tendon andthe sliding surface of the joint member to be reduced to a minimum,facilitating the miniaturization of the jointed device.

Due to the provision of a fabrication method based on EDM as previouslydescribed, suitable to transfer only thermal stimulation to theworkpieces, it is possible to obtain parts of submillimeter dimensions,allowing an extreme miniaturization of said medical instrument 60, stillmaintaining a satisfying cut precision due to the provision of cuttingon a plurality of workpieces in a single passing.

Due to the provision of a tool, as well as a method of EDM according toone aspect of the invention, suitable for performing, with a single wirepassing, the cut of parts in a plurality of workpieces which will beassembled together after machining, it is possible to obtain matingswith millimetric precision, particularly suitable for buildingrotational joints features such as prongs, pivot holes, profiles ofjoint members, allowing hence to reliably mount pieces by snap-fit, orwith controlled backlash between the same parts.

Due to the provision of a robotic assembly 100, comprising at least onecontrol instrument that replicates a traditional surgical instrument aswell as a control device comprising an ergonomic support element for theoperator, it is possible to improve the familiarity and ergonomics ofthe surgeon, improving the outcome of the surgical operation and patientcomfort as a consequence.

Due to the provision of a robotic assembly according to one aspect ofthe invention, comprising a macro-positioning arm having a mechanicalstructure of arm members, as well as highly rigid joints, it is possibleto avoid structural mechanical vibrations at the terminal portion of theinstrument, and hence facilitate the surgeon's work.

Although some combinations of embodiments described above can be seen inthe attached figures, an expert of the field will also be able toconfigure combinations not shown in the figures, without departing fromthe scope of the following claims.

To satisfy specific and temporary needs, a person skilled in the art cancarry out a number of modifications, adaptations and substitutions ofelements with other functionally equivalent elements, without departingfrom the scope of the following claims.

REFERENCE LIST

-   7 work volume, or common workspace volume-   9 tendon-   16 point of intersection-   18 proximal tendon portion-   19 distal tendon portion-   20 control device-   21 control instrument-   22 detection device-   23 connection cable-   24 communication and power cable-   25 operator support surface-   26 status signal light-   27 operator support element-   28 position sensor-   29 tip sensor-   30 macro-positioning arm-   31 first arm member-   32 second arm member-   33 third arm member-   34 fourth arm member-   35 release button, or brake release button-   36 linear sliding guide-   37 manual knob-   38 support member-   39 attachment feature-   40 sliding surface-   41 micro-positioning device-   43 rotation dial nut-   45 video camera-   46 motorized rotary joint-   47 base portion-   48 plunger locking hole-   49 machining groove-   50 tendon drive system-   51 first motorized slide, or first motorized micro-slide-   52 second motorized slide, or second motorized micro-slide-   53 third motorized slide, or third motorized micro-slide-   54 first slide rail-   55 second slide rail-   56 third slide rail-   57 frame-   58 first frame portion, or upper frame-   59 second frame portion, drum, or lower frame-   60 medical instrument or micro-instrument or surgical    micro-instrument-   61 motor box-   62 mechanical transmission box-   63 sharp edge of lateral sliding surface-   64 continuity surface of lateral gliding surface-   65 shaft, or hollow shaft-   67 control device base structure-   68 tip portion of control device-   69 forceps articulation of control device-   70 jointed or articulated device-   71 first member or first joint member, or first link-   72 second member or second joint member, or second link-   73 third member or third joint member, or third link-   74 fourth member or fourth joint member, or fourth link-   75 elbow member, or elbow link-   76 fastening pin-   77 terminal device, or terminal member, or terminal portion-   78 wrist member or wrist joint member-   79 pin hole-   80 sliding surface or joint sliding surface-   81 prong-   82 tendon termination feature, or tendon fastening point.-   83 surface-   84 tendon fastening surface-   86 winding surface, or ruled winding surface-   87 sterile barrier-   88 shoulder surface-   89 tendon guide element-   90 tendon, or actuation cable, or tendon of a first pair of tendons-   90′ jacket-   90″ core-   90′″ coating-   91 first endpoint or first tendon endpoint, or proximal tendon    endpoint, or first tendon termination-   92 second endpoint or second tendon endpoint, or distal tendon    endpoint, or second tendon termination-   92′ tendon distal portion-   93 tendon deflectable portion or deflectable portion-   94 pusher assembly or pushing means-   95 pushing element, piston, actuation piston or linear actuation    piston.-   96 plunger or sliding shaft-   97 guiding elements, or tendon guiding elements, or guiding pulleys-   98 plunger idle pulley-   99 tensioning element, or oretensioning element, or spring-   100 robotic assembly, or robotic surgical assembly, or surgical    robotic assembly, robotic assembly for micro-surgery or    microsurgical robotic assembly-   102 operating table-   103 vision system, microscope, or surgical microscope-   104 support or cart-   105 foot platform-   106 retractable handle-   107 power cable-   108 control panel-   109 communication cable-   110 cutting profile, or cutting line-   111 display-   112 machining fixture-   113 first fixing surface of the first pair of fixing surfaces-   114 second fixing surface of the first pair of fixing surfaces-   115 cutting wire, or EDM wire, or electrical discharge machine wire-   116 member holes or member seats-   117 workpieces or pieces to be machined-   118 reference rod-   120 first control device-   122 first rod portion-   123 second rod portion-   125 guide hole or opening-   134 first fixing surface of the second pair of fixing surfaces-   135 second fixing surface of the second pair of fixing surfaces-   141 first micro-positioning device-   145 first portion of plunger-   146 second portion of plunger-   147 pushing surface-   148 reciprocal pushing surface-   150 sensor-   151 force sensor-   152 pressure sensor-   153 proximity sensor-   160 first medical instrument-   170 first jointed device-   171 rotational joint-   172 jointing portion-   173 spherical joint-   177 first portion of terminal member-   190 opposite tendon, or opposite tendon of a first pair of tendons-   191 tendon of a second pair of tendons-   192 opposite tendon of a second pair of tendons-   194 opposite pusher assembly or opposite pushing means-   197 first guiding element, or first guiding pulleys-   199 opposite tensioning element, opposite pretensioning element, or    opposite spring-   210 second cut profile-   220 second control device-   221 second control instrument-   241 second micro-positioning device-   260 second medical instrument-   270 second jointed device-   277 second portion of terminal member-   297 second tendon guiding element, or second tendon guiding pulley-   397 third tendon guiding element, or third tendon guiding pulley.-   497 fourth tendon guiding element, or fourth tendon guiding pulley.-   200 surgeon, or microsurgeon-   201 patient-   202 surgical needle-   341 third micro-positioning device-   360 third medical instrument-   T-T tendon direction or tendon path-   X-X longitudinal shaft direction, or instrument axis-   P-P pitch axis, or first axis of joint movement-   Y-Y yaw axis, or second axis of joint movement-   a-a first axis of arm movement-   b-b second axis of arm movement-   c-c third axis of arm movement-   d-d fourth axis of arm movement-   e-e longitudinal axis of base portion of macropositioning arm-   f-f first slide direction-   g-g second slide direction-   h-h third slide direction-   r-r longitudinal axis of rotation-   X-Y first cutting plane-   Y-Z second cutting plane-   X-Z third cutting plane-   θ shaft angle

1. A robotic surgery assembly comprising a medical instrumentcomprising: a frame; a jointed device having a degree of freedom withrespect of said frame; and at least one tendon made of polymer fibersdesigned for actuating said degree of freedom; wherein said tendoncomprises a tendon endpoint connected to the medical instrument to exerta tensile load for actuating said degree of freedom.
 2. The assembly ofclaim 1, wherein said at least one tendon slides while in contact on atleast one portion of said jointed device to actuate said degree offreedom, and said degree of freedom is a rotational joint.
 3. Theassembly of claim 2, wherein said at least one portion of the jointeddevice on which said at least one tendon slides while in contact isformed by a convex, ruled surface formed by a plurality of straightgenerator lines parallel to a rotational axis of said rotational joint.4. The assembly of claim 1, wherein said at least one tendon is made ofstrands.
 5. The assembly of claim 4, wherein the at least one tendon ismade of braided strands, the strands comprising said polymeric fibers.6. The assembly of claim 4, wherein said at least one tendon is made ofstrands having different dimensions/sizes.
 7. The assembly of claim 5,wherein said at least one tendon has a pick per inches (PPI) of 20-60.8. The assembly of claim 5, wherein the PPI of said at least one tendonis higher at a distal portion of thereof, said distal portion beinglocated near said tendon endpoint.
 9. The assembly of claim 8, whereinsaid distal portion having higher PPI has length equal or less than ⅓ ofa length of the tendon.
 10. The assembly of claim 1, wherein said atleast one tendon have an elastic module between 50 GPa and 100 GPa. 11.The assembly of claim 1, wherein tendon stiffness varies along thelength of the tendon.
 12. The assembly of claim 1, wherein the jointeddevice comprises a tendon fastening point where the tendon endpoint isconnected, wherein the frame comprises a shaft, and wherein said atleast one tendon is more flexible proximate or at a tendon fasteningpoint and is stiffer close to or inside said shaft.
 13. The assembly ofclaim 1, wherein said at least one tendon comprises a distal portionlocated proximate the tendon endpoint, said distal portion is braidedwith PPI of 25-100.
 14. The assembly of claim 1, wherein said at leastone tendon comprises a longitudinal portion which is braided with PPI of3-25.
 15. The assembly of claim 1, wherein said at least one tendon hasa curvature radius inferior or equal to one millimeter.
 16. The assemblyof claim 1, wherein said at least one tendon has a diameter, variable indifferent portions thereof.
 17. The assembly of claim 16, wherein saidat least one tendon is thinner at said tendon endpoint.
 18. The assemblyof claim 1, wherein said at least one tendon has diameter between 0.05mm and 0.3 mm.
 19. The assembly of claim 1, wherein said at least onetendon has composition variable in different portions thereof.
 20. Theassembly of claim 1, wherein said at least one tendon has a core and ajacket.
 21. The assembly of claim 20, wherein said jacket and/or thecore is made of braided polymeric strands.
 22. The assembly of claim 21,wherein said jacket is braided with PPI of 25-100.
 23. The assembly ofclaim 21, wherein said core is braided with PPI of 3-30.
 24. Theassembly of claim 20, wherein the strands of the braided jacket havetransverse dimension, for example the diameter, inferior to thetransverse dimension, for example the diameter, of the strands of thebraided core.
 25. The assembly of claim 20, wherein the strands of thebraided jacket have linear density inferior to the linear density of thestrands of the braided core.
 26. The assembly of claim 20, wherein saidjacket is or comprises a chemical coating made of PDMS and/or PTFE. 27.The assembly of claim 1, wherein said at least one tendon is made ofpolyethylene. UHMWPE, Kevlar, Vectran, Zylon, or PBO, or combinationthereof.
 28. The assembly of claim 8, wherein said distal portion havinghigher PPI has a length equal or less than 1/10 of a length of thetendon.
 29. The assembly of claim 8, wherein said distal portion havinghigher PPI has a length equal or less than 1/20 of a length of thetendon.
 30. The assembly of claim 1, wherein said at least one tendoncomprises a distal portion located proximate the tendon endpoint, saiddistal portion is braided with PPI of 50-100.